Healthcare Provider Details

I. General information

NPI: 1942195169
Provider Name (Legal Business Name): HELEN PHAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 10/04/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4011 TALBOT RD S STE 500
RENTON WA
98055-5782
US

IV. Provider business mailing address

2512 125TH PL SW
EVERETT WA
98204-5400
US

V. Phone/Fax

Practice location:
  • Phone: 425-690-3482
  • Fax:
Mailing address:
  • Phone: 206-504-0156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.PA.70172736
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: