Healthcare Provider Details

I. General information

NPI: 1003443920
Provider Name (Legal Business Name): ANNELISE YOO MAH-SOM MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNELISE YOO MAH

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC ST
SEATTLE WA
98195-6110
US

IV. Provider business mailing address

PO BOX 50095
SEATTLE WA
98145-5095
US

V. Phone/Fax

Practice location:
  • Phone: 206-520-5000
  • Fax:
Mailing address:
  • Phone: 206-520-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD61509328
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License NumberMD61509328
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: