Provider Demographics
NPI:1710970207
Name:SHIU, SAMUEL Y (MD)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:Y
Last Name:SHIU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 116TH AVE NE
Mailing Address - Street 2:#200
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
Practice Address - Street 2:# 200
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
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD32279207Q00000X
WAMD00032279208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA010064233OtherRR MEDICARE
WA1113380Medicaid
WAGAB13163Medicare PIN
G07998Medicare UPIN
WAAB13163Medicare ID - Type Unspecified