Basic Information
| Provider Information | |||||||||
| NPI: | 1114571148 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | XIE | ||||||||
| FirstName: | LYNN | ||||||||
| MiddleName: | YU | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21017 NE 115TH ST | ||||||||
| Address2: | |||||||||
| City: | REDMOND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980532106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2103811300 | ||||||||
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| Practice Location | |||||||||
| Address1: | 527 BOREN AVE N | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981095502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062741211 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2019 | ||||||||
| LastUpdateDate: | 07/29/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | DE60974829 | WA | Y | Dental Providers | Dentist |
No ID Information.