Provider Demographics
NPI:1285727545
Name:PHAM, HUONG T (MD)
Entity type:Individual
Prefix:
First Name:HUONG
Middle Name:T
Last Name:PHAM
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 1:1100 OLIVE WAY # MS /M4-PA
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1873
Mailing Address - Country:US
Mailing Address - Phone:206-515-5811
Mailing Address - Fax:
Practice Address - Street 1:1100 9TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2756
Practice Address - Country:US
Practice Address - Phone:206-223-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-01
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000393192085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1194PHOtherBLUE SHIELD #
WA920006183OtherRAILROAD MEDICARE
AKMD5027WMedicaid
WA0039587OtherLABOR AND INDUSTRIES #
WA8271868Medicaid
WAUS2456197OtherAETNA SPECIALIST PIN
G91227Medicare UPIN
WA8895972Medicare PIN
WA1194PHOtherBLUE SHIELD #
WAAB20242Medicare PIN