Healthcare Provider Details

I. General information

NPI: 1487580304
Provider Name (Legal Business Name): DOMINIC BUI ELIAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3639 MARTIN LUTHER KING JR WAY S
SEATTLE WA
98144-6847
US

IV. Provider business mailing address

4218 ROOSEVELT WAY NE APT 607
SEATTLE WA
98105-6182
US

V. Phone/Fax

Practice location:
  • Phone: 206-695-7600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: