Provider Demographics
NPI:1871060988
Name:NGUYEN, KHOA DANG SR (LPN)
Entity type:Individual
Prefix:MR
First Name:KHOA
Middle Name:DANG
Last Name:NGUYEN
Suffix:SR
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5106 S GARDEN LOOP RD
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-5700
Mailing Address - Country:US
Mailing Address - Phone:360-918-2968
Mailing Address - Fax:
Practice Address - Street 1:21851 84TH AVE S STE 101
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-1958
Practice Address - Country:US
Practice Address - Phone:425-947-2462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-26
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP.60861815164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse