Provider Demographics
NPI:1609353747
Name:PHAM, MAIANH CHRISTINA (DMD)
Entity Type:Individual
Prefix:DR
First Name:MAIANH
Middle Name:CHRISTINA
Last Name:PHAM
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 1:1205 N 10TH PL APT 2108
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-5476
Mailing Address - Country:US
Mailing Address - Phone:850-207-2323
Mailing Address - Fax:
Practice Address - Street 1:444 RAMSAY WAY STE 109
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-4536
Practice Address - Country:US
Practice Address - Phone:253-237-6903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-22
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN23357122300000X
WADE60879436122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist