# BELLEVUE OBGYN LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104124247
- **Authorized official:** DR. MARK S FAN MD (MEMBER)
- **Authorized official phone:** (425) 698-1588

## Contact information

- **Practice address:** 1515 116TH AVE NE, 205, BELLEVUE, WA 98004-3811
- **Practice address phone:** (425) 698-1588
- **Mailing address:** 1515 116TH AVE NE, SUITE 205, BELLEVUE, WA 98004-3811
- **Mailing address phone:** (425) 698-1588

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | MD60122545 | WA | Yes |

## Other

- **Enumeration date:** 03/13/2011
- **Last updated:** 08/10/2012