Basic Information
| Provider Information | |||||||||
| NPI: | 1710441902 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DOAN | ||||||||
| FirstName: | NGOC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25248 PACIFIC HWY S STE 105 | ||||||||
| Address2: | |||||||||
| City: | KENT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980326530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2532602929 | ||||||||
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| Practice Location | |||||||||
| Address1: | 25248 PACIFIC HWY S STE 105 | ||||||||
| Address2: | |||||||||
| City: | KENT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539465766 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2019 | ||||||||
| LastUpdateDate: | 02/16/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | DE60924969 | WA | Y | Dental Providers | Dentist |
No ID Information.