Provider Demographics
NPI:1962494070
Name:NGUYEN, MINH VAN (MD)
Entity Type:Individual
Prefix:
First Name:MINH
Middle Name:VAN
Last Name:NGUYEN
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 1:9431 17TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98106-2710
Mailing Address - Country:US
Mailing Address - Phone:206-763-9621
Mailing Address - Fax:206-767-6028
Practice Address - Street 1:9431 17TH AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98106-2710
Practice Address - Country:US
Practice Address - Phone:206-763-9621
Practice Address - Fax:206-767-6028
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00020746208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1004548Medicaid
A05990Medicare UPIN