Provider Demographics
NPI:1558380188
Name:LU, KIMBERLY (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:LU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 NW GILMAN BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-5398
Mailing Address - Country:US
Mailing Address - Phone:425-392-8282
Mailing Address - Fax:425-391-2957
Practice Address - Street 1:1505 NW GILMAN BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-5398
Practice Address - Country:US
Practice Address - Phone:425-392-8282
Practice Address - Fax:425-391-2957
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000416022086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7589760OtherAETNA
WA020750700-98065-A002OtherTRICARE
WA0431LUOtherREGENCE BLUE SHIELD
WA0201780OtherLABOR AND INDUSTRIES
WA0201780OtherLABOR AND INDUSTRIES
WA7589760OtherAETNA