Provider Demographics
NPI:1912439373
Name:OVERLAKE INTERNAL MEDICINE ASSOCIATES INC., PS
Entity type:Organization
Organization Name:OVERLAKE INTERNAL MEDICINE ASSOCIATES INC., PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:NGHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GIANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-974-7601
Mailing Address - Street 1:1427 116TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3807
Mailing Address - Country:US
Mailing Address - Phone:425-462-9800
Mailing Address - Fax:425-454-9143
Practice Address - Street 1:1427 116TH AVE NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3807
Practice Address - Country:US
Practice Address - Phone:425-462-9800
Practice Address - Fax:425-454-9143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-03
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty