Healthcare Provider Details

I. General information

NPI: 1073133294
Provider Name (Legal Business Name): STEVE THANH DUC PHAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2020
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1119 HIGHLAND AVE STE 5
CLARKSTON WA
99403-2836
US

IV. Provider business mailing address

1441 N 12TH ST FL 1
PHOENIX AZ
85006-2837
US

V. Phone/Fax

Practice location:
  • Phone: 509-751-0312
  • Fax: 509-751-0314
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD.MD.00043844
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: