Provider Demographics
NPI:1538331665
Name:PHAM, KHANH NGOC (MD)
Entity Type:Individual
Prefix:DR
First Name:KHANH
Middle Name:NGOC
Last Name:PHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1135 116TH AVE NE STE 620
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-4636
Mailing Address - Country:US
Mailing Address - Phone:425-454-8016
Mailing Address - Fax:425-453-2827
Practice Address - Street 1:1135 116TH AVE NE STE 620
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-4636
Practice Address - Country:US
Practice Address - Phone:425-454-8016
Practice Address - Fax:425-453-2827
Is Sole Proprietor?:No
Enumeration Date:2008-03-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD60337799208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2030225Medicaid