Individual
LEI Y LIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
21600 HIGHWAY 99, SUITE 260, EDMONDS, WA 98026-8012
(425) 774-2650
(425) 774-2643
Mailing address
PO BOX 34888, SEATTLE, WA 98124-1888
(425) 977-4620
(425) 745-9836
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
01067717A
IN
207RG0100X
Gastroenterology Physician
Primary
MD60363646
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0317311
LABOR AND INDUSTRIES
WA
05
—
2030035
—
WA
Enumeration date
08/19/2006
Last updated
12/21/2021
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