Provider Demographics
NPI:1609945732
Name:PHAM, DAVID XUAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:XUAN
Last Name:PHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 S JACKSON ST STE 27
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-2065
Mailing Address - Country:US
Mailing Address - Phone:206-324-8469
Mailing Address - Fax:
Practice Address - Street 1:1200 S JACKSON ST STE 27
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-2065
Practice Address - Country:US
Practice Address - Phone:206-324-8469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00022298174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1032648Medicaid
WA000106841Medicare ID - Type Unspecified
WAE34172Medicare UPIN