MEDICARE: TUAN MY LIEU MD MEDICAL OFFICE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD00020719	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528120441
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TUAN MY LIEU MD MEDICAL OFFICE

Provider Business Mailing Address
First Line	:	4739 1-2 RAINIER AVENUE SOUTH
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98118-1657
Country	:	US
Telephone Number	:	206-725-0119
Fax Number	:	206-725-8829

Provider Business Practice Location Address
First Line	:	4739 1-2 RAINIER AVENUE SOUTH
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98118-1657
Country	:	US
Telephone Number	:	206-725-0119
Fax Number	:	206-725-8829

Authorized Official
Title or Position	:	MD PHYSICIAN
Name	:	MR. TUAN MY LIEU
Credential	:	MD
Telephone Number	:	206-725-0119

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	03/07/2023

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