Healthcare Provider Details

I. General information

NPI: 1275754657
Provider Name (Legal Business Name): ANN SHIH-LONG LU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 04/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10025 NE 186TH ST
BOTHELL WA
98011-3839
US

IV. Provider business mailing address

10025 NE 186TH ST
BOTHELL WA
98011-3839
US

V. Phone/Fax

Practice location:
  • Phone: 425-486-9131
  • Fax: 425-486-9490
Mailing address:
  • Phone: 425-486-9131
  • Fax: 425-486-9490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00046848
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: