Healthcare Provider Details

I. General information

NPI: 1023039997
Provider Name (Legal Business Name): MILLIE Y. TUNG, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 116TH AVE NE SUITE B
BELLEVUE WA
98004-3031
US

IV. Provider business mailing address

PO BOX 13684
SEATTLE WA
98198-1010
US

V. Phone/Fax

Practice location:
  • Phone: 425-453-8406
  • Fax: 425-453-4173
Mailing address:
  • Phone: 206-592-5000
  • Fax: 206-824-9510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. MILLIE Y TUNG II
Title or Position: OWNER
Credential: MD
Phone: 425-453-8406