=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518809193
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PEGASUS ANESTHESIA LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2026
-----------------------------------------------------
Last Update Date | 04/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3500 NE JOHN OLSEN AVE
-----------------------------------------------------
City | HILLSBORO
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 971-227-3312
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14671 SW MILLIKAN WAY
-----------------------------------------------------
City | BEAVERTON
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97003-2999
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 971-227-3312
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. HAI PHAM
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 971-227-3312
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------