Provider Demographics
NPI:1265465793
Name:SAMUEL Y SHIU
Entity Type:Organization
Organization Name:SAMUEL Y SHIU
Other - Org Name:THE PROMISE FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:Y
Authorized Official - Last Name:SHIU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-462-7333
Mailing Address - Street 1:1940 116TH AVE NE STE 200
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3074
Mailing Address - Country:US
Mailing Address - Phone:425-462-7333
Mailing Address - Fax:425-462-5641
Practice Address - Street 1:1940 116TH AVE NE STE 200
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3074
Practice Address - Country:US
Practice Address - Phone:425-462-7333
Practice Address - Fax:425-462-5641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA010064233OtherRR MEDICARE
WA1113380Medicaid
WAG07998Medicare UPIN
WA010064233OtherRR MEDICARE