Provider Demographics
NPI:1114571148
Name:XIE, LYNN YU (DDS)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:YU
Last Name:XIE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21017 NE 115TH ST
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98053-2106
Mailing Address - Country:US
Mailing Address - Phone:210-381-1300
Mailing Address - Fax:
Practice Address - Street 1:527 BOREN AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-5502
Practice Address - Country:US
Practice Address - Phone:206-274-1211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60974829122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist