Provider Demographics
NPI:1366601965
Name:LI, JUDY (DO)
Entity type:Individual
Prefix:DR
First Name:JUDY
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:4033 TALBOT RD S STE 230
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5700
Mailing Address - Country:US
Mailing Address - Phone:425-690-3585
Mailing Address - Fax:425-690-9585
Practice Address - Street 1:4033 TALBOT RD S STE 230
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5700
Practice Address - Country:US
Practice Address - Phone:425-690-3585
Practice Address - Fax:425-690-9585
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP60459577208000000X, 2084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics