Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MT201870 | PA |
N | 111NI0900X | Internist | MT201870 | PA |
Y | 207SG0201X | Clinical Genetics (M.D.) | ML60566212 | WA |
NPI | 1235494105 |
---|---|
Provider Name | Dr. Prasit Phowthongkum |
First Address | Seattle, WA 98105-3537 |
Second Address | Seattle, WA 98195 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2012 |
Last Update Date | 02/07/2015 |