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General NPI Number Information
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NPI Number | 1457694127
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Entity Type | Organization
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Legal Business Name | MAI PHAM, MD PS
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Dates
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Enumeration Date | 04/01/2013
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Last Update Date | 04/01/2013
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Provider Practice Location Address
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Address Line | 7315 212TH ST SW SUITE 103
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City | EDMONDS
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State | WA
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Zip | 98026-7610
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Country | US
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Telephone | 206-322-2000
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Fax | 206-322-2001
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Provider Business Mailing Address
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Address Line | 7315 212TH ST SW SUITE 103
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City | EDMONDS
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State | WA
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Zip | 98026-7610
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Country | US
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Telephone | 206-322-2000
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Fax | 206-322-2001
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Authorized Official
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Title or Position | VASCULAR SURGEON
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Name | DR. MAI THANH PHAM
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Credential | MD
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Telephone | 206-322-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | MD00048340
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License Number State | WA
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