Provider Demographics
NPI:1710952379
Name:LENG, VUTHY (MD)
Entity Type:Individual
Prefix:DR
First Name:VUTHY
Middle Name:
Last Name:LENG
Suffix:
Gender:M
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:PO BOX 6015
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98063-6015
Mailing Address - Country:US
Mailing Address - Phone:253-336-4462
Mailing Address - Fax:253-838-4145
Practice Address - Street 1:34618 11TH PL S. SUITE #100
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003
Practice Address - Country:US
Practice Address - Phone:866-499-8990
Practice Address - Fax:253-838-4145
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044823207Q00000X
WA00044823207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1122118Medicaid
WA1122118Medicaid