Provider Demographics
NPI:1245695741
Name:TIEU, LEE KIM I (LMP)
Entity type:Individual
Prefix:MR
First Name:LEE
Middle Name:KIM
Last Name:TIEU
Suffix:I
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9909 168TH ST E
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-2513
Mailing Address - Country:US
Mailing Address - Phone:253-445-3000
Mailing Address - Fax:
Practice Address - Street 1:9909 168TH ST E
Practice Address - Street 2:SUITE 102
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-2513
Practice Address - Country:US
Practice Address - Phone:253-445-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60475807225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist