Provider Demographics
NPI:1457694127
Name:MAI PHAM, MD PS
Entity Type:Organization
Organization Name:MAI PHAM, MD PS
Other - Org Name:SEATTLE VASCULAR SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VASCULAR SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:MAI
Authorized Official - Middle Name:THANH
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-322-2000
Mailing Address - Street 1:7315 212TH ST SW
Mailing Address - Street 2:SUITE 103
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7610
Mailing Address - Country:US
Mailing Address - Phone:206-322-2000
Mailing Address - Fax:206-322-2001
Practice Address - Street 1:7315 212TH ST SW
Practice Address - Street 2:SUITE 103
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7610
Practice Address - Country:US
Practice Address - Phone:206-322-2000
Practice Address - Fax:206-322-2001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-01
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00048340261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center