1497133193 NPI number — LIEM DO, LACAMAS, LLC

Table of content: (NPI 1497133193)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497133193 NPI number — LIEM DO, LACAMAS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIEM DO, LACAMAS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497133193
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13510 NE 84TH ST
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98682-3092
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-696-0000
Provider Business Mailing Address Fax Number:
360-896-6264

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
155 NE 192ND AVE
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
CAMAS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98607-7477
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-696-0000
Provider Business Practice Location Address Fax Number:
360-896-6264
Provider Enumeration Date:
05/13/2015

Additional Information

Authorized Official

Authorized Official Last Name:
DO
Authorized Official First Name:
LIEM
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
360-696-0000

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DE8159 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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