Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD61114625 | WA |
NPI | 1003106675 |
---|---|
Provider Name | Xin Jie Luo |
First Address | Seattle, WA 98116-4647 |
Second Address | Seattle, WA 98116-4647 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2011 |
Last Update Date | 03/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2175619 | (05) | WA |