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General NPI Number Information
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NPI Number | 1972171866
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Entity Type | Individual
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Provider Name | SHAWN LOU PHAM DDS
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Gender | Male
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Dates
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Enumeration Date | 06/16/2021
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Last Update Date | 06/16/2021
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Provider Practice Location Address
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Address Line | 14212 AMBAUM BLVD SW STE 1
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City | BURIEN
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State | WA
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Zip | 98166-1437
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Country | US
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Telephone | 206-343-0000
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Fax |
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Provider Business Mailing Address
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Address Line | 650 DUVALL AVE NE APT R1323
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City | RENTON
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State | WA
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Zip | 98059-4775
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Country | US
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Telephone | 253-222-9269
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DENT.DE.61184555
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License Number State | WA
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