Healthcare Provider Details

I. General information

NPI: 1306686092
Provider Name (Legal Business Name): THAO-CHI PHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2024
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4555 DELRIDGE WAY SW
SEATTLE WA
98106-1379
US

IV. Provider business mailing address

4555 DELRIDGE WAY SW
SEATTLE WA
98106-1379
US

V. Phone/Fax

Practice location:
  • Phone: 626-884-5337
  • Fax:
Mailing address:
  • Phone: 626-884-5337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMG.70012425
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: