Healthcare Provider Details

I. General information

NPI: 1265455612
Provider Name (Legal Business Name): WUACA K LUNA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 04/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4033 TALBOT RD S STE 570
RENTON WA
98055-5772
US

IV. Provider business mailing address

3600 LIND AVE SW STE 100
RENTON WA
98055-4934
US

V. Phone/Fax

Practice location:
  • Phone: 425-656-5400
  • Fax:
Mailing address:
  • Phone: 425-656-5412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00040633
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberMD00040633
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: