1790727535 NPI number — DR. YEN-TSUN LAI M.D.

Table of content: DR. YEN-TSUN LAI M.D. (NPI 1790727535)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790727535 NPI number — DR. YEN-TSUN LAI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAI
Provider First Name:
YEN-TSUN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1790727535
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/26/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3600 LIND AVE SW
Provider Second Line Business Mailing Address:
SUITE 100 CREDENTIALING
Provider Business Mailing Address City Name:
RENTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98057-4970
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-228-3440
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4033 TALBOT RD S STE 570
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RENTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-690-3489
Provider Business Practice Location Address Fax Number:
425-690-9089
Provider Enumeration Date:
06/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  MD00042518 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: MD00042518 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0300X , with the licence number: MD00042518 , 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)

  • Identifier: 8365520 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: G8978329 . This is a "MEDICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1030627 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00627784 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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