Healthcare Provider Details

I. General information

NPI: 1114871076
Provider Name (Legal Business Name): LILY JI JIANG PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 S COLUMBIAN WAY
SEATTLE WA
98108-1532
US

IV. Provider business mailing address

1660 S COLUMBIAN WAY
SEATTLE WA
98108-1532
US

V. Phone/Fax

Practice location:
  • Phone: 510-488-3842
  • Fax:
Mailing address:
  • Phone: 206-277-3318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSYC.PY.70064716
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: