Provider Demographics
NPI:1649527987
Name:NGO, PHU HOANG DUC (PA)
Entity type:Individual
Prefix:
First Name:PHU
Middle Name:HOANG DUC
Last Name:NGO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2217 152ND AVE NE, SUITE 100
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-9805
Mailing Address - Country:US
Mailing Address - Phone:425-825-3900
Mailing Address - Fax:425-821-2549
Practice Address - Street 1:4400 37TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-1609
Practice Address - Country:US
Practice Address - Phone:206-461-6957
Practice Address - Fax:206-461-7810
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAPA60305256363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant