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General NPI Number Information
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NPI Number | 1619462793
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Entity Type | Individual
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Provider Name | QUYNH NHU THI PHAN DO
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Gender | Female
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Dates
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Enumeration Date | 06/29/2018
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Last Update Date | 11/22/2025
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Provider Practice Location Address
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Address Line | 1940 116TH AVE NE STE 200A
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City | BELLEVUE
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State | WA
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Zip | 98004-3097
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Country | US
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Telephone | 415-209-4331
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Fax |
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Provider Business Mailing Address
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Address Line | CCM MEDICINE, 710 S 340TH ST, STE B
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City | FEDERAL WAY
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State | WA
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Zip | 98003
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Country | US
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Telephone |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | DO.OP.70042948
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License Number State | WA
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