Provider Demographics
NPI:1730541707
Name:DU, LINGYUN
Entity type:Individual
Prefix:
First Name:LINGYUN
Middle Name:
Last Name:DU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5127
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5127
Mailing Address - Country:US
Mailing Address - Phone:206-401-3142
Mailing Address - Fax:206-401-3201
Practice Address - Street 1:2438 N PONDEROSA DR STE C105
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-2465
Practice Address - Country:US
Practice Address - Phone:805-388-2068
Practice Address - Fax:805-484-7700
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61016144207N00000X
390200000X
CAA167622207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program