Individual
VAN TUY PHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
11311 BRIDGEPORT WAY SW STE 100, LAKEWOOD, WA 98499-3096
(253) 985-6490
(253) 985-6488
Mailing address
11311 BRIDGEPORT WAY SW STE 100, LAKEWOOD, WA 98499-3096
(253) 985-6490
(253) 985-6488
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA10004199
WA
363AS0400X
Surgical Physician Assistant
Primary
PA10004199
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0262968
LNI
WA
05
—
1042154
—
WA
01
—
G8891647
MEDICARE PTAN
WA
01
—
P00918654
MEDICARE RR
WA
Enumeration date
02/15/2007
Last updated
01/20/2021
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