Active NPI
Ai-Khue Thi Nguyen, M.D.
- Family Medicine Physician
- Puyallup, WA
National Provider Identifier
1104934629
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MD00044973
- Practice address
- 1007 39TH Ave SE
Puyallup, WA 98374-2192 - Phone
- (253) 435-3100
- Fax
- (253) 435-3138
- NPI assigned
- Aug 25, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD00044973 | WA | Primary |
Addresses
Primary practice location
1007 39TH Ave SE
Puyallup, WA 98374-2192
Mailing address
1007 39TH Ave SE
Puyallup, WA 98374-2192
Phone (253) 435-3100
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 203361 | Other | WA | L&I |
| 3386NG | Other | REGENCE BLUESHIELD | |
| 8447468 | Medicaid | WA | |
| 7107805 | Other | AETNA |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepicwa.kp.org:14430/Interconnect-CE-PRD/wcf/epic.community.hie/xcpdrespondinggatewaysync | Health Information Exchange (HIE) |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD00044973 | WA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kaiser Foundation Health Plan of Washington | Family Medicine | Current | Accepting new patients |
| Kaiser Foundation Health Plan of Washington | Current | Accepting new patients | |
| Kaiser Foundation Health Plan of Washington | Current | Accepting new patients |
Locations
19379 7th Ave NE
Poulsbo, WA 98370
Phone (360) 394-1000
1007 39th Ave SE
Puyallup, WA 98374
Phone (253) 435-3100
200 15th Ave E
Seattle, WA 98112
Phone (206) 326-4530
9505 S Steele St
Tacoma, WA 98444
Phone (253) 597-6800
Interoperability endpoints
- anguyen152955@ghc.direct-ci.net
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Multi-Specialty Clinic/Center
- Seattle, WA
- NPI 1396810701
-
- Multi-Specialty Clinic/Center
- Everett, WA
- NPI 1386935351
-
- Multi-Specialty Clinic/Center
- Renton, WA
- NPI 1669619870
Family Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156464000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1619568000000",
"number": "1104934629",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1007 39TH AVE SE",
"city": "PUYALLUP",
"state": "WA",
"postal_code": "983742192",
"telephone_number": "253-435-3100",
"fax_number": "253-435-3138"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1007 39TH AVE SE",
"city": "PUYALLUP",
"state": "WA",
"postal_code": "983742192",
"telephone_number": "253-435-3100",
"fax_number": "253-435-3138"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NGUYEN",
"first_name": "AI-KHUE",
"middle_name": "THI",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-25",
"last_updated": "2021-04-28",
"certification_date": "2021-04-28",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WA",
"license": "MD00044973",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "L&I",
"identifier": "203361",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BLUESHIELD",
"identifier": "3386NG",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8447468",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "7107805",
"state": null
}
],
"endpoints": [
{
"endpointType": "SOAP",
"endpointTypeDescription": "SOAP URL",
"endpoint": "https://careepicwa.kp.org:14430/Interconnect-CE-PRD/wcf/epic.community.hie/xcpdrespondinggatewaysync",
"affiliation": "N",
"endpointDescription": "Carequality",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "C-CDA",
"address_1": "1007 39th Ave SE",
"city": "Puyallup",
"state": "WA",
"country_code": "US",
"postal_code": "983742192",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Puyallup, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.