Healthcare Provider Details

I. General information

NPI: 1053817205
Provider Name (Legal Business Name): NAM PHAM DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 06/22/2024
Certification Date: 06/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4033 TALBOT RD S STE 570
RENTON WA
98055-5700
US

IV. Provider business mailing address

4033 TALBOT RD S STE 570
RENTON WA
98055-5700
US

V. Phone/Fax

Practice location:
  • Phone: 425-690-3487
  • Fax: 425-690-9087
Mailing address:
  • Phone: 425-690-3487
  • Fax: 425-690-9087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOT018441
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS021735
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberOT018441
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: