MEDICARE: LINGYUN DU

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	207N00000X	Dermatology Physician	MD61016144	WA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207N00000X	Dermatology Physician	A167622	CA

General Provider Information

NPI Number	:	1730541707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINGYUN DU

Provider Business Mailing Address
First Line	:	PO BOX 5127
Second Line	:
City	:	EVERETT
State	:	WA
Zip	:	98206-5127
Country	:	US
Telephone Number	:	206-401-3142
Fax Number	:	206-401-3201

Provider Business Practice Location Address
First Line	:	2438 N PONDEROSA DR STE C105
Second Line	:
City	:	CAMARILLO
State	:	CA
Zip	:	93010-2465
Country	:	US
Telephone Number	:	805-388-2068
Fax Number	:	805-484-7700

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2016
Last Update Date	:	03/11/2024

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Directions to “ LINGYUN DU ” Practice Location

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