Provider Demographics
NPI:1235247123
Name:KWEE, LILY SIOELI (DMD)
Entity Type:Individual
Prefix:DR
First Name:LILY
Middle Name:SIOELI
Last Name:KWEE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 PACIFIC AVE STE 300
Mailing Address - Street 2:ATTN CREDENTIALING
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-4488
Mailing Address - Country:US
Mailing Address - Phone:253-597-4550
Mailing Address - Fax:253-597-4556
Practice Address - Street 1:10510 GRAVELLY LAKE DR SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-5036
Practice Address - Country:US
Practice Address - Phone:253-589-7188
Practice Address - Fax:253-284-4384
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000078201223G0001X
NV48961223G0001X
TX250701223G0001X
KY42701223G0001X
PADS0381281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
3815KWOtherREGENCE BLUESHIELD
WA5049069Medicaid
WA7820WAOtherWASHINGTON DENTAL