Healthcare Provider Details

I. General information

NPI: 1982302162
Provider Name (Legal Business Name): LUCIA LIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2023
Last Update Date: 07/02/2023
Certification Date: 07/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UW DEPARTMENT OF ORAL SURGERY 1959 NE PACIFIC ST
SEATTLE WA
98195-0001
US

IV. Provider business mailing address

46 LEXINGTON GDNS
NORTH HAVEN CT
06473-3473
US

V. Phone/Fax

Practice location:
  • Phone: 206-543-7722
  • Fax:
Mailing address:
  • Phone: 203-752-6933
  • 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 Code122300000X
TaxonomyDentist
License NumberDR61425108
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: