Provider Demographics
NPI:1568683969
Name:NGUYEN, THU VAN
Entity Type:Individual
Prefix:
First Name:THU
Middle Name:VAN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7101 MARTIN LUTHER KING JR WAY S STE 216
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-3592
Mailing Address - Country:US
Mailing Address - Phone:206-721-3589
Mailing Address - Fax:
Practice Address - Street 1:7101 MARTIN LUTHER KING JR WAY S STE 216
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-3592
Practice Address - Country:US
Practice Address - Phone:206-721-3589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN188122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist