Healthcare Provider Details

I. General information

NPI: 1942827357
Provider Name (Legal Business Name): TIN BO NICHOLAS LAM MB BCH BAO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2020
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SAND POINT WAY NE
SEATTLE WA
98105-3901
US

IV. Provider business mailing address

4800 SAND POINT WAY NE M/S OB.9.620.1
SEATTLE WA
98105-3901
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-2521
  • Fax:
Mailing address:
  • Phone: 206-987-2521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberMD.MD.70135639
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: