Healthcare Provider Details

I. General information

NPI: 1104048594
Provider Name (Legal Business Name): PARTNER ONCOLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 02/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1519 3RD ST SE SUITE 260
PUYALLUP WA
98372
US

IV. Provider business mailing address

1519 3RD ST SE SUITE 260
PUYALLUP WA
98372
US

V. Phone/Fax

Practice location:
  • Phone: 253-770-1700
  • Fax: 253-770-1702
Mailing address:
  • Phone: 253-770-1700
  • Fax: 253-770-1702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License NumberBL07-00297
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD00036160
License Number StateWA

VIII. Authorized Official

Name: DR. XINSHENG MICHAEL LIAO
Title or Position: CEO/PRESIDENT
Credential: M.D. PHD
Phone: 253-770-1700