Provider Demographics
NPI:1740858414
Name:PHAN, AN D
Entity type:Individual
Prefix:
First Name:AN
Middle Name:D
Last Name:PHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14607 52ND AVE W UNIT 402
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-3853
Mailing Address - Country:US
Mailing Address - Phone:425-405-2157
Mailing Address - Fax:
Practice Address - Street 1:14607 52ND AVE W UNIT 402
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-3853
Practice Address - Country:US
Practice Address - Phone:425-405-2157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter