Basic Information
| Provider Information | |||||||||
| NPI: | 1972942365 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NAING | ||||||||
| FirstName: | MIN | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D., | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1130 N 185TH ST STE 201 | ||||||||
| Address2: | |||||||||
| City: | SHORELINE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981334011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065421000 | ||||||||
| FaxNumber: | 2065425353 | ||||||||
| Practice Location | |||||||||
| Address1: | 1130 N 185TH ST STE 201 | ||||||||
| Address2: | |||||||||
| City: | SHORELINE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065421000 | ||||||||
| FaxNumber: | 2065425353 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2013 | ||||||||
| LastUpdateDate: | 07/24/2018 | ||||||||
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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 | 207RN0300X | MD60823915 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 2101667 | 05 | WA | MEDICAID |