Provider Demographics
NPI:1437368388
Name:PHAM, ANGIE KHUE-VI (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGIE
Middle Name:KHUE-VI
Last Name:PHAM
Suffix:
Gender:F
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:PO BOX 34245
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1245
Mailing Address - Country:US
Mailing Address - Phone:206-622-7747
Mailing Address - Fax:206-467-1470
Practice Address - Street 1:1001 SW KLICKITAT WAY
Practice Address - Street 2:SUITE 205
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98134-1161
Practice Address - Country:US
Practice Address - Phone:206-622-7747
Practice Address - Fax:206-467-1470
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA92586207ZP0102X
WAMD60118420207ZP0102X, 207ZH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA258441OtherDEPARTMENT OF LABOR & INDUSTRIES
WA8563595Medicaid
WAP00873143OtherRAILROAD MEDICARE
WA8563595Medicaid