Provider Demographics
NPI:1720032691
Name:YU, MUJUN (MD, PHD)
Entity Type:Individual
Prefix:
First Name:MUJUN
Middle Name:
Last Name:YU
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13751 LAKE CITY WAY NE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-8612
Mailing Address - Country:US
Mailing Address - Phone:206-623-3814
Mailing Address - Fax:206-623-4327
Practice Address - Street 1:13751 LAKE CITY WAY NE
Practice Address - Street 2:SUITE 300
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-8612
Practice Address - Country:US
Practice Address - Phone:206-623-3814
Practice Address - Fax:206-623-4327
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00039264207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM52837Medicaid
WA8278038Medicaid
WA8278038Medicaid
WAG8859709Medicare PIN
NM52837Medicaid
WAG8859710Medicare PIN
H34448Medicare UPIN
NM2400356Medicare PIN
WAG8859711Medicare PIN