Provider Demographics
NPI:1235494105
Name:PHOWTHONGKUM, PRASIT (MD)
Entity Type:Individual
Prefix:DR
First Name:PRASIT
Middle Name:
Last Name:PHOWTHONGKUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5240 UNIVERSITY WAY NE
Mailing Address - Street 2:APT 519
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-3537
Mailing Address - Country:US
Mailing Address - Phone:267-210-7008
Mailing Address - Fax:
Practice Address - Street 1:HEALTH SCIENCES BLDG K-253
Practice Address - Street 2:UNIVERSITY OF WASHINGTON,DIVISION OF MEDICAL GENETICS
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195
Practice Address - Country:US
Practice Address - Phone:206-616-4521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-06
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT201870207R00000X
WAML60566212207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine