Provider Demographics
NPI:1841574720
Name:TO, DUNG TRI (LMP)
Entity Type:Individual
Prefix:MR
First Name:DUNG
Middle Name:TRI
Last Name:TO
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:BEN
Other - Middle Name:
Other - Last Name:TO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMP
Mailing Address - Street 1:2345 BOYLSTON AVE E
Mailing Address - Street 2:#102
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3364
Mailing Address - Country:US
Mailing Address - Phone:509-499-2312
Mailing Address - Fax:
Practice Address - Street 1:2345 BOYLSTON AVE E
Practice Address - Street 2:#102
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3364
Practice Address - Country:US
Practice Address - Phone:509-499-2312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60179972225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist