Basic Information
| Provider Information | |||||||||
| NPI: | 1861759896 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CONLEY | ||||||||
| FirstName: | SOPHIA | ||||||||
| MiddleName: | WU | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 25608 | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841250608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063204476 | ||||||||
| FaxNumber: | 4258818746 | ||||||||
| Practice Location | |||||||||
| Address1: | 18100 NE UNION HILL RD FL 2 | ||||||||
| Address2: | |||||||||
| City: | REDMOND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980523330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4258815437 | ||||||||
| FaxNumber: | 4259474521 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2012 | ||||||||
| LastUpdateDate: | 08/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | A113718 | CA | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 60445634 | WA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.