Provider Demographics
NPI:1114153749
Name:PHANTANA-ANGKOOL, APRIL (MD)
Entity type:Individual
Prefix:
First Name:APRIL
Middle Name:
Last Name:PHANTANA-ANGKOOL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 116TH AVE NE STE 200
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-4695
Mailing Address - Country:US
Mailing Address - Phone:425-688-0212
Mailing Address - Fax:425-688-0213
Practice Address - Street 1:1135 116TH AVE NE STE 200
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-4695
Practice Address - Country:US
Practice Address - Phone:425-688-0212
Practice Address - Fax:425-688-0213
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60545613208600000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0349642OtherSTATE L&I
WA0349642OtherSTATE L&I