Provider Demographics
NPI:1770650822
Name:LAU, KIM K (DPM)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:K
Last Name:LAU
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:14213 AMBAUM BLVD SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98166
Mailing Address - Country:US
Mailing Address - Phone:206-243-9222
Mailing Address - Fax:206-243-3343
Practice Address - Street 1:14213 AMBAUM BLVD SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98166
Practice Address - Country:US
Practice Address - Phone:206-243-9222
Practice Address - Fax:206-243-3343
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAPO00000562213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALA3297OtherREGENCE BLUE SHIELD
WA1098466Medicaid
WA362789100OtherUS DEPT OF LABOR (DFEC)
WA1135430001OtherMEDICAL SUPPLY NUMBER
WA480027779OtherRAILROAD MEDICARE
WA108702OtherLABOR AND INDUSTRIES (WA)
WA362789100OtherUS DEPT OF LABOR (DFEC)
WALA3297OtherREGENCE BLUE SHIELD