Provider Demographics
NPI:1912757097
Name:LEE, TINA TIANYU
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:TIANYU
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25029 122ND WAY SE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-5659
Mailing Address - Country:US
Mailing Address - Phone:503-333-3453
Mailing Address - Fax:
Practice Address - Street 1:25029 122ND WAY SE
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-5659
Practice Address - Country:US
Practice Address - Phone:503-333-3453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program