Healthcare Provider Details

I. General information

NPI: 1790727535
Provider Name (Legal Business Name): YEN-TSUN LAI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 11/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4033 TALBOT RD S STE 570
RENTON WA
98055
US

IV. Provider business mailing address

3600 LIND AVE SW SUITE 100 CREDENTIALING
RENTON WA
98057-4970
US

V. Phone/Fax

Practice location:
  • Phone: 425-690-3489
  • Fax: 425-690-9089
Mailing address:
  • Phone: 425-228-3440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD00042518
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD00042518
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberMD00042518
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: