Organization
BELLEVUE OBGYN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK S FAN MD (MEMBER)
(425) 698-1588
Entity
Organization
Contact information
Practice address
1515 116TH AVE NE, 205, BELLEVUE, WA 98004-3811
(425) 698-1588
Mailing address
1515 116TH AVE NE, SUITE 205, BELLEVUE, WA 98004-3811
(425) 698-1588
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
MD60122545
WA
Other
Enumeration date
03/13/2011
Last updated
08/10/2012
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