Provider Demographics
NPI:1053817205
Name:PHAM, NAM (DO)
Entity type:Individual
Prefix:
First Name:NAM
Middle Name:
Last Name:PHAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4033 TALBOT RD S STE 570
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5700
Mailing Address - Country:US
Mailing Address - Phone:425-690-3487
Mailing Address - Fax:425-690-9087
Practice Address - Street 1:4033 TALBOT RD S STE 570
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5700
Practice Address - Country:US
Practice Address - Phone:425-690-3487
Practice Address - Fax:425-690-9087
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2024-06-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOT018441207R00000X, 207RI0200X
PAOS021735207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine