Provider Demographics
NPI:1841420593
Name:PATRICK PHAN, M.D., P.S.
Entity Type:Organization
Organization Name:PATRICK PHAN, M.D., P.S.
Other - Org Name:PATRICK PHAN, M.D., P.S.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:T
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-725-4322
Mailing Address - Street 1:2902 112TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-7528
Mailing Address - Country:US
Mailing Address - Phone:206-725-4322
Mailing Address - Fax:
Practice Address - Street 1:2902 112TH AVE SE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-7528
Practice Address - Country:US
Practice Address - Phone:206-725-4322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000263462084P0800X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1087196Medicaid
WA1086792Medicaid
WA1982800Medicaid
WA1982800Medicaid
WA1087196Medicaid