Healthcare Provider Details

I. General information

NPI: 1861759896
Provider Name (Legal Business Name): SOPHIA WU CONLEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2012
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18100 NE UNION HILL RD FL 2
REDMOND WA
98052-3330
US

IV. Provider business mailing address

PO BOX 25608
SALT LAKE CITY UT
84125-0608
US

V. Phone/Fax

Practice location:
  • Phone: 425-881-5437
  • Fax: 425-947-4521
Mailing address:
  • Phone: 206-320-4476
  • Fax: 425-881-8746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA113718
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number60445634
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: