Organization
JACKSON MEDICAL CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID PHAM (MD)
(206) 324-8469
Entity
Organization
Contact information
Practice address
1200 S JACKSON ST, SUITE 27, SEATTLE, WA 98144-2026
(206) 324-8469
Mailing address
1200 S JACKSON ST, SUITE 27, SEATTLE, WA 98144-2026
(206) 324-8469
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1032648
—
WA
Enumeration date
03/02/2016
Last updated
03/02/2016
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