Provider Demographics
NPI:1053426734
Name:SEATAC PRIMARY CARE PHYSICIANS, INC.
Entity type:Organization
Organization Name:SEATAC PRIMARY CARE PHYSICIANS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDY-LINH
Authorized Official - Middle Name:HUNG
Authorized Official - Last Name:VU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-242-7333
Mailing Address - Street 1:13100 MILITARY RD S
Mailing Address - Street 2:STE #2
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98168-3086
Mailing Address - Country:US
Mailing Address - Phone:206-242-7333
Mailing Address - Fax:206-242-7335
Practice Address - Street 1:13100 MILITARY RD S
Practice Address - Street 2:STE #2
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98168-3086
Practice Address - Country:US
Practice Address - Phone:206-242-7333
Practice Address - Fax:206-242-7335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00042278207Q00000X
WAMD00042368207Q00000X
WAMD00046713207Q00000X
WAMD00046816207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA=========OtherTAX ID