Provider Demographics
NPI:1386754661
Name:LAKES FAMILY MEDICINE, PS
Entity type:Organization
Organization Name:LAKES FAMILY MEDICINE, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINH
Authorized Official - Middle Name:T
Authorized Official - Last Name:HUYNH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-864-0224
Mailing Address - Street 1:10116 116TH ST E
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-3543
Mailing Address - Country:US
Mailing Address - Phone:253-864-0224
Mailing Address - Fax:253-864-0634
Practice Address - Street 1:10116 116TH ST E
Practice Address - Street 2:SUITE 101
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3543
Practice Address - Country:US
Practice Address - Phone:253-864-0224
Practice Address - Fax:253-864-0634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD0037764261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8250888Medicaid
WA8251944Medicaid
WAAB33513Medicare ID - Type Unspecified
WAH43502Medicare UPIN
WAAB33512Medicare ID - Type Unspecified
WAH09897Medicare UPIN