Basic Information
| Provider Information | |||||||||
| NPI: | 1033136486 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BILAN | ||||||||
| FirstName: | YURIY | ||||||||
| MiddleName: | |||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 205 10TH ST NE | ||||||||
| Address2: | |||||||||
| City: | AUBURN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980024045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2533515300 | ||||||||
| FaxNumber: | 2536276576 | ||||||||
| Practice Location | |||||||||
| Address1: | 205 10TH ST NE | ||||||||
| Address2: | |||||||||
| City: | AUBURN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980024045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2533515300 | ||||||||
| FaxNumber: | 2536276576 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2006 | ||||||||
| LastUpdateDate: | 12/01/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA10004202 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363A00000X | PA10004202 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 1000777 | 05 | WA | MEDICAID | 8196743 | 05 | WA | MEDICAID | P00028557 | 01 | RAILROAD MEDICARE | OTHER |