Provider Demographics
NPI:1598802399
Name:LUONG, TAI H (MD)
Entity Type:Individual
Prefix:
First Name:TAI
Middle Name:H
Last Name:LUONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1780 NW MYHRE RD
Mailing Address - Street 2:SUITE 1220
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8676
Mailing Address - Country:US
Mailing Address - Phone:360-337-6500
Mailing Address - Fax:360-337-6523
Practice Address - Street 1:1780 NW MYHRE RD
Practice Address - Street 2:SUITE 1220
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8676
Practice Address - Country:US
Practice Address - Phone:360-337-6500
Practice Address - Fax:360-337-6523
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000359612085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAF90429Medicare UPIN