Healthcare Provider Details

I. General information

NPI: 1811439532
Provider Name (Legal Business Name): DAVID LILE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2016
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8725 S 212TH ST
KENT WA
98031-1921
US

IV. Provider business mailing address

8725 S 212TH ST
KENT WA
98031-1921
US

V. Phone/Fax

Practice location:
  • Phone: 253-981-4746
  • Fax:
Mailing address:
  • Phone: 253-981-4746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLABA.AB.70082367
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: