Provider Demographics
NPI:1073253175
Name:PHAM, TRISTAN (DO)
Entity Type:Individual
Prefix:
First Name:TRISTAN
Middle Name:
Last Name:PHAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 SENECA ST
Mailing Address - Street 2:MAIL STOP: H8-GME
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:925 SENECA ST
Practice Address - Street 2:MAIL STOP: H8-GME
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2742
Practice Address - Country:US
Practice Address - Phone:206-583-6079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-29
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program