Basic Information
| Provider Information | |||||||||
| NPI: | 1649527987 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NGO | ||||||||
| FirstName: | PHU | ||||||||
| MiddleName: | HOANG DUC | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2217 152ND AVE NE, SUITE 100 | ||||||||
| Address2: | |||||||||
| City: | REDMOND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980529805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4258253900 | ||||||||
| FaxNumber: | 4258212549 | ||||||||
| Practice Location | |||||||||
| Address1: | 4400 37TH AVE S | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981181609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2064616957 | ||||||||
| FaxNumber: | 2064617810 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2012 | ||||||||
| LastUpdateDate: | 12/16/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA60305256 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.