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General NPI Number Information
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NPI Number | 1235494105
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Entity Type | Individual
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Provider Name | PRASIT PHOWTHONGKUM M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/06/2012
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Last Update Date | 07/02/2015
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Provider Practice Location Address
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Address Line | HEALTH SCIENCES BLDG K-253 UNIVERSITY OF WASHINGTON,DIVISION OF MEDICAL GENETICS
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City | SEATTLE
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State | WA
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Zip | 98195
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Country | US
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Telephone | 206-616-4521
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Fax |
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Provider Business Mailing Address
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Address Line | 5240 UNIVERSITY WAY NE APT 519
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City | SEATTLE
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State | WA
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Zip | 98105-3537
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Country | US
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Telephone | 267-210-7008
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MT201870
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207SG0201X
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Taxonomy Name | Clinical Genetics (M.D.) Physician
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License Number | ML60566212
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License Number State | WA
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