Healthcare Provider Details

I. General information

NPI: 1689179293
Provider Name (Legal Business Name): CHRISTINA LIEU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 MADISON ST STE 600
SEATTLE WA
98104-1340
US

IV. Provider business mailing address

1101 MADISON ST STE 600
SEATTLE WA
98104-1340
US

V. Phone/Fax

Practice location:
  • Phone: 206-215-2020
  • Fax: 206-215-2022
Mailing address:
  • Phone: 206-215-2020
  • Fax: 206-215-2022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License NumberMD61410393
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD61410393
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number291489
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: