Healthcare Provider Details

I. General information

NPI: 1922758697
Provider Name (Legal Business Name): YILAN LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC ST
SEATTLE WA
98195-1415
US

IV. Provider business mailing address

1959 NE PACIFIC ST., PO BOX 356043
SEATTLE WA
98195
US

V. Phone/Fax

Practice location:
  • Phone: 206-598-4121
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberML61432051
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: