MEDICARE: DR. DANIEL PHAM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	MD60078773	WA
2	2085R0202X	Diagnostic Radiology Physician	A89077	CA

General Provider Information

NPI Number	:	1568658524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL PHAM MD

Provider Business Mailing Address
First Line	:	1320 E DIVISION ST
Second Line	:
City	:	MOUNT VERNON
State	:	WA
Zip	:	98274-4133
Country	:	US
Telephone Number	:	415-203-6328
Fax Number	:

Provider Business Practice Location Address
First Line	:	1320 E DIVISION ST
Second Line	:
City	:	MOUNT VERNON
State	:	WA
Zip	:	98274-4133
Country	:	US
Telephone Number	:	415-203-6328
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2007
Last Update Date	:	12/04/2025

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