Healthcare Provider Details

I. General information

NPI: 1417816505
Provider Name (Legal Business Name): JESSICA PHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DUPONT CIR NW STE 600
WASHINGTON DC
20036-1106
US

IV. Provider business mailing address

1 DUPONT CIR NW STE 600
WASHINGTON DC
20036-1106
US

V. Phone/Fax

Practice location:
  • Phone: 202-758-2502
  • Fax:
Mailing address:
  • Phone: 202-758-2502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number789790902
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: