Basic Information
| Provider Information | |||||||||
| NPI: | 1003106675 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LUO | ||||||||
| FirstName: | XIN | ||||||||
| MiddleName: | JIE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4755 FAUNTLEROY WAY SW | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981164647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062010551 | ||||||||
| FaxNumber: | 2062010552 | ||||||||
| Practice Location | |||||||||
| Address1: | 4755 FAUNTLEROY WAY SW | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981164647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062010551 | ||||||||
| FaxNumber: | 2062010552 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2011 | ||||||||
| LastUpdateDate: | 08/03/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD61114625 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2175619 | 05 | WA | MEDICAID |