Healthcare Provider Details

I. General information

NPI: 1447056585
Provider Name (Legal Business Name): WASHINGTON ENDOMETRIOSIS AND COMPLEX SURGERY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2025
Last Update Date: 01/30/2026
Certification Date: 01/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5225 WISCONSIN AVE NW STE 513
WASHINGTON DC
20015-2024
US

IV. Provider business mailing address

5225 WISCONSIN AVE NW STE 513
WASHINGTON DC
20015-2024
US

V. Phone/Fax

Practice location:
  • Phone: 771-210-4437
  • Fax:
Mailing address:
  • Phone: 771-888-2061
  • Fax: 771-210-2017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MIMI ZAW-PHAM
Title or Position: PRACTICE MANAGER
Credential:
Phone: 771-888-2061