Healthcare Provider Details

I. General information

NPI: 1770650822
Provider Name (Legal Business Name): KIM K. LAU D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14213 AMBAUM BLVD SW
SEATTLE WA
98166
US

IV. Provider business mailing address

14213 AMBAUM BLVD SW
SEATTLE WA
98166
US

V. Phone/Fax

Practice location:
  • Phone: 206-243-9222
  • Fax: 206-243-3343
Mailing address:
  • Phone: 206-243-9222
  • Fax: 206-243-3343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO00000562
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO00000562
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: