Provider Demographics
NPI:1629205257
Name:NGUYEN, TRUNG QUOC (LMP, LMT)
Entity Type:Individual
Prefix:
First Name:TRUNG
Middle Name:QUOC
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:LMP, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 NE 82ND AVE
Mailing Address - Street 2:APARTMENT #270
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-2057
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:717 NE 82ND AVE
Practice Address - Street 2:APARTMENT #270
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-2057
Practice Address - Country:US
Practice Address - Phone:360-567-5628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA38057225700000X
WAMA00025146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist