Individual
IM S YI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
26004 104TH AVE SE, KENT, WA 98030-7677
(425) 251-4040
Mailing address
26004 104TH AVE SE, KENT, WA 98030-7677
(425) 251-4040
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
01055784
IN
207Q00000X
Family Medicine Physician
Primary
MD00047267
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000373612
ANTHEM
IN
05
—
8497141
—
WA
Enumeration date
11/02/2005
Last updated
05/12/2021
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