Provider Demographics
NPI:1396044418
Name:SHEN-VASEN, YU LISA (MD)
Entity Type:Individual
Prefix:
First Name:YU
Middle Name:LISA
Last Name:SHEN-VASEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:YU
Other - Middle Name:LISA
Other - Last Name:SHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1145 BROADWAY FL 2
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-4201
Mailing Address - Country:US
Mailing Address - Phone:206-860-5414
Mailing Address - Fax:
Practice Address - Street 1:904 7TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-1132
Practice Address - Country:US
Practice Address - Phone:206-292-2249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-16
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60221582208000000X
CAA112686208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2013533Medicaid
WAG8934868Medicare PIN