Provider Demographics
NPI:1225497969
Name:PHANDINH CLINIC LLC
Entity Type:Organization
Organization Name:PHANDINH CLINIC LLC
Other - Org Name:PHANDINH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KHUU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-324-4745
Mailing Address - Street 1:330 SW 43RD ST STE L
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-4900
Mailing Address - Country:US
Mailing Address - Phone:425-243-2349
Mailing Address - Fax:
Practice Address - Street 1:330 SW 43RD ST STE L
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-4900
Practice Address - Country:US
Practice Address - Phone:425-243-2349
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-22
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60616795261Q00000X
261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center