Provider Demographics
NPI:1376158410
Name:DO, LUAN KIM
Entity Type:Individual
Prefix:
First Name:LUAN
Middle Name:KIM
Last Name:DO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25052
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98093-2052
Mailing Address - Country:US
Mailing Address - Phone:206-708-5177
Mailing Address - Fax:
Practice Address - Street 1:1832 POINTE WOODWORTH DR NE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98422-3466
Practice Address - Country:US
Practice Address - Phone:206-708-5177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor