Basic Information
| Provider Information | |||||||||
| NPI: | 1851398770 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | WU | ||||||||
| FirstName: | LILLIAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 955 POWELL AVE SW | ||||||||
| Address2: | SUITE A | ||||||||
| City: | RENTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980552908 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 126 AUBURN AVE | ||||||||
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| City: | AUBURN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980025057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2537350166 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2005 | ||||||||
| LastUpdateDate: | 12/04/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD00035659 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.