Basic Information
| Provider Information | |||||||||
| NPI: | 1124080734 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NGUYEN | ||||||||
| FirstName: | BICH-KHANH | ||||||||
| MiddleName: | T. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7320 216TH ST SW | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | EDMONDS | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980268006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256404901 | ||||||||
| FaxNumber: | 4256404919 | ||||||||
| Practice Location | |||||||||
| Address1: | 7320 216TH ST SW | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | EDMONDS | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980268006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256404901 | ||||||||
| FaxNumber: | 4256404919 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2006 | ||||||||
| LastUpdateDate: | 10/08/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD00028424 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 39114 | 01 | WA | LABOR AND INDUSTRIES | OTHER | 1079136 | 05 | WA | MEDICAID | 7358256 | 01 | AETNA | OTHER | R52987 | 01 | WA | REGENCE | OTHER | R52987 | 01 | BLUE CROSS/BLUE SHIELD | OTHER |