Individual
LINDA KIM PHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5165 MCCARTY LN, LAFAYETTE, IN 47905-8764
(765) 448-8000
(765) 838-4758
Mailing address
2212 S 12TH ST, TACOMA, WA 98405-3026
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01094355A
IN
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
01094355A
IN
207RP1001X
Pulmonary Disease Physician
01094355A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300096078
—
IN
01
—
815500692
MEDICARE PTAN
IN
Enumeration date
03/20/2018
Last updated
10/01/2024
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