Provider Demographics
NPI:1306859293
Name:PHAN, HOAICHI (DMD)
Entity Type:Individual
Prefix:DR
First Name:HOAICHI
Middle Name:
Last Name:PHAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18123 E VALLEY HWY
Mailing Address - Street 2:SUITE B-104
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-1007
Mailing Address - Country:US
Mailing Address - Phone:425-656-2919
Mailing Address - Fax:425-656-7878
Practice Address - Street 1:18123 E VALLEY HWY
Practice Address - Street 2:SUITE B-104
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-1007
Practice Address - Country:US
Practice Address - Phone:425-656-2919
Practice Address - Fax:425-656-7878
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000101021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice