Provider Demographics
NPI:1679264485
Name:ACTIVE WOUND HEALING
Entity Type:Organization
Organization Name:ACTIVE WOUND HEALING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HUY
Authorized Official - Middle Name:
Authorized Official - Last Name:DANG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:253-363-2911
Mailing Address - Street 1:13709 210TH ST E
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98338-6625
Mailing Address - Country:US
Mailing Address - Phone:360-229-4438
Mailing Address - Fax:855-696-7932
Practice Address - Street 1:13709 210TH ST E
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:WA
Practice Address - Zip Code:98338-6625
Practice Address - Country:US
Practice Address - Phone:360-229-4438
Practice Address - Fax:855-696-7932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-15
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty