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General NPI Number Information
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NPI Number | 1720031578
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Entity Type | Organization
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Legal Business Name | CQHB LLC
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 11/20/2007
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Provider Practice Location Address
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Address Line | 747 BROADWAY
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City | SEATTLE
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State | WA
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Zip | 98122-4379
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Country | US
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Telephone | 206-386-6000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 34940
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City | SEATTLE
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State | WA
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Zip | 98124-1940
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Country | US
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Telephone | 503-372-2740
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Fax | 503-372-2754
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Authorized Official
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Title or Position | PRESIDENT
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Name | CONG YU
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Credential | MD
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Telephone | 503-372-2740
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | MD00041359
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | MD00041359
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License Number State | WA
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