Healthcare Provider Details

I. General information

NPI: 1235461955
Provider Name (Legal Business Name): MINH H PHAM L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2010
Last Update Date: 02/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2103 152ND AVE NE
REDMOND WA
98052-5520
US

IV. Provider business mailing address

21404 36TH DR SE
BOTHELL WA
98021-7064
US

V. Phone/Fax

Practice location:
  • Phone: 206-853-4693
  • Fax:
Mailing address:
  • Phone: 206-478-1290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC60088469
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: