Provider Demographics
NPI:1710238050
Name:KHANHLAM K PHAN DDS PLLC
Entity Type:Organization
Organization Name:KHANHLAM K PHAN DDS PLLC
Other - Org Name:ROSE HILL DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KHANHLAM
Authorized Official - Middle Name:K
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-822-4300
Mailing Address - Street 1:8532 122ND AVE NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-5831
Mailing Address - Country:US
Mailing Address - Phone:425-822-4100
Mailing Address - Fax:425-822-4300
Practice Address - Street 1:8532 122ND AVE NE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-5831
Practice Address - Country:US
Practice Address - Phone:425-822-4100
Practice Address - Fax:425-822-4300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE601970841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty