Provider Demographics
NPI:1780657924
Name:VASCULAR SURGERY NW PS
Entity Type:Organization
Organization Name:VASCULAR SURGERY NW PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:HB
Authorized Official - Last Name:YU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-572-2844
Mailing Address - Street 1:11311 BRIDGEPORT WAY SW
Mailing Address - Street 2:#203
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499
Mailing Address - Country:US
Mailing Address - Phone:253-572-2844
Mailing Address - Fax:253-572-2841
Practice Address - Street 1:11311 BRIDGEPORT WAY SW
Practice Address - Street 2:#203
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499
Practice Address - Country:US
Practice Address - Phone:253-572-2844
Practice Address - Fax:253-572-2841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7076797Medicaid
0430430OtherL AND I