Individual
DR. MARK S FAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1515 116TH AVE NE STE 205, BELLEVUE, WA 98004-3811
(310) 866-3707
(425) 999-4858
Mailing address
PO BOX 741, MERCER ISLAND, WA 98040-0741
(425) 999-4858
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
A112478
CA
207V00000X
Obstetrics & Gynecology Physician
MD60122545
WA
207V00000X
Obstetrics & Gynecology Physician
Primary
NOT YET
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0264461
STATE L&I
WA
Enumeration date
07/05/2008
Last updated
02/03/2021
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