Healthcare Provider Details

I. General information

NPI: 1861320376
Provider Name (Legal Business Name): MICHAEL YUNXI LOU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 QUEEN ANNE AVE N
SEATTLE WA
98109-4980
US

IV. Provider business mailing address

201 NE 103RD ST APT 302
SEATTLE WA
98125-7104
US

V. Phone/Fax

Practice location:
  • Phone: 206-593-3131
  • Fax:
Mailing address:
  • Phone: 972-400-2472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number70139473
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: