Basic Information
| Provider Information | |||||||||
| NPI: | 1619292596 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OVERLAKE SLEEP DISORDERS CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 112TH AVE NE | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980044511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252893000 | ||||||||
| FaxNumber: | 4252893240 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 112TH AVE NE | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980044511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252893000 | ||||||||
| FaxNumber: | 4252893240 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2010 | ||||||||
| LastUpdateDate: | 06/20/2019 | ||||||||
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| AuthorizedOfficialLastName: | GIANG | ||||||||
| AuthorizedOfficialFirstName: | NGHIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4259747601 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RS0012X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine |
No ID Information.