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General NPI Number Information
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NPI Number | 1649569146
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Entity Type | Organization
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Legal Business Name | MINH VAN PHAM MD INC PS
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Dates
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Enumeration Date | 04/05/2011
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Last Update Date | 07/26/2014
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Provider Practice Location Address
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Address Line | 5401 RAINIER AVE S
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City | SEATTLE
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State | WA
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Zip | 98118-2438
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Country | US
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Telephone | 206-722-6268
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Fax | 206-725-5435
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Provider Business Mailing Address
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Address Line | 5401 RAINIER AVE S
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City | SEATTLE
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State | WA
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Zip | 98118-2438
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Country | US
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Telephone | 206-722-6268
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Fax | 206-725-5435
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Authorized Official
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Title or Position | GENERAL PRACTICE MD
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Name | DR. MINH VAN PHAM
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Credential | M.D.
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Telephone | 206-722-6268
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 0021481
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License Number State | WA
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