Healthcare Provider Details

I. General information

NPI: 1629996533
Provider Name (Legal Business Name): DANH PHAM DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25248 PACIFIC HWY S STE 105
KENT WA
98032-6530
US

IV. Provider business mailing address

25248 PACIFIC HWY S STE 105
KENT WA
98032-6530
US

V. Phone/Fax

Practice location:
  • Phone: 125-394-6576
  • Fax:
Mailing address:
  • Phone: 125-394-6576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDENT.DE.70118413
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: