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Individual

SU LEI TIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
34503 9TH AVE S, FEDERAL WAY, WA 98003-8727
(253) 835-8700
(253) 835-8000
Mailing address
34503 9TH AVE S STE 100, FEDERAL WAY, WA 98003-8726
(253) 835-8700
(253) 835-8000

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD61091055
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2161950
WA
Enumeration date
06/30/2017
Last updated
09/23/2020
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