Provider Demographics
NPI:1699824110
Name:NGUYEN, THUCUC THI-THU (MD)
Entity Type:Individual
Prefix:DR
First Name:THUCUC
Middle Name:THI-THU
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9725 SE 36TH ST
Mailing Address - Street 2:SUITE
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-3841
Mailing Address - Country:US
Mailing Address - Phone:206-236-5553
Mailing Address - Fax:206-236-0506
Practice Address - Street 1:9725 SE 36TH ST
Practice Address - Street 2:SUITE
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-3841
Practice Address - Country:US
Practice Address - Phone:206-236-5553
Practice Address - Fax:206-236-0506
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000266822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
4308909OtherAETNA PIN #
NG5663OtherREGENCE PIN#