Basic Information
| Provider Information | |||||||||
| NPI: | 1598716144 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LESAGE | ||||||||
| FirstName: | HUI-YING | ||||||||
| MiddleName: | THERESA | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HUANG | ||||||||
| OtherFirstName: | HUI-YING | ||||||||
| OtherMiddleName: | THERESA | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 873 HINOTES CT | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | LYNDEN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982649043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603189705 | ||||||||
| FaxNumber: | 3603188735 | ||||||||
| Practice Location | |||||||||
| Address1: | 2075 BARKLEY BLVD | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | BELLINGHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982266614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606713345 | ||||||||
| FaxNumber: | 3606501354 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 11/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD00034049 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3976LE | 01 | WA | REGENCE | OTHER | 8210890 | 05 | WA | MEDICAID |