Individual
KHAMPHOUCANH SOUTHISOMBATH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
32018 23RD AVE S, FEDERAL WAY, WA 98003-6022
(206) 520-5000
(206) 520-1799
Mailing address
PO BOX 50095, SEATTLE, WA 98145-5095
(206) 520-5700
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD60658344
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1114316734
—
WA
Enumeration date
01/20/2015
Last updated
07/17/2025
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