Provider Demographics
NPI:1508054669
Name:PHAM, NGOC-TRUNG (DDS)
Entity Type:Individual
Prefix:
First Name:NGOC-TRUNG
Middle Name:
Last Name:PHAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 RAINIER AVE S
Mailing Address - Street 2:SO. #203
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-2085
Mailing Address - Country:US
Mailing Address - Phone:206-726-9711
Mailing Address - Fax:
Practice Address - Street 1:502 RAINIER AVE S
Practice Address - Street 2:SO. #203
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-2085
Practice Address - Country:US
Practice Address - Phone:206-726-9711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-13
Last Update Date:2007-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA67461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice