Provider Demographics
NPI:1811939945
Name:LI, SUYANG (MD)
Entity type:Individual
Prefix:
First Name:SUYANG
Middle Name:
Last Name:LI
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:P.O. BOX 3497
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98063
Mailing Address - Country:US
Mailing Address - Phone:253-838-0219
Mailing Address - Fax:253-838-3449
Practice Address - Street 1:32114 FIRST AVE. S.
Practice Address - Street 2:STE 203
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003
Practice Address - Country:US
Practice Address - Phone:253-838-0219
Practice Address - Fax:253-838-3449
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00046108174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No174400000XOther Service ProvidersSpecialist