Provider Demographics
NPI:1710011226
Name:NGUYEN-PHAM, MAI T (ND)
Entity Type:Individual
Prefix:DR
First Name:MAI
Middle Name:T
Last Name:NGUYEN-PHAM
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9989 SW NIMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-7150
Mailing Address - Country:US
Mailing Address - Phone:503-644-7100
Mailing Address - Fax:503-644-7110
Practice Address - Street 1:9989 SW NIMBUS AVE
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-7150
Practice Address - Country:US
Practice Address - Phone:503-644-7100
Practice Address - Fax:503-644-7110
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1553175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath