Provider Demographics
NPI:1023449295
Name:PHAN, HIEP (LPN)
Entity type:Individual
Prefix:
First Name:HIEP
Middle Name:
Last Name:PHAN
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:TYLOR
Other - Middle Name:HIEP
Other - Last Name:PHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2541 29TH AVE S
Mailing Address - Street 2:#11
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-5429
Mailing Address - Country:US
Mailing Address - Phone:206-883-2150
Mailing Address - Fax:206-567-9802
Practice Address - Street 1:2541 29TH AVE S APT 11
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-5416
Practice Address - Country:US
Practice Address - Phone:206-883-2150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP60235112164W00000X
WAMC11816171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No171R00000XOther Service ProvidersInterpreter