Bellevue OBGYN LLC

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

MD60122545 Issued in WA

Legal business name

BELLEVUE OBGYN LLC

Practice address

1515 116TH Ave NE
205
Bellevue, WA 98004-3811

Phone

(425) 698-1588

NPI assigned

Mar 13, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mark S Fan, MD

Title

Member

Phone

(425) 698-1588

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1299974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1344556800000",
    "number": "1104124247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 116TH AVE NE",
            "address_2": "SUITE 205",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980043811",
            "telephone_number": "425-698-1588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 116TH AVE NE",
            "address_2": "205",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980043811",
            "telephone_number": "425-698-1588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BELLEVUE OBGYN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-13",
        "last_updated": "2012-08-10",
        "status": "A",
        "authorized_official_last_name": "FAN",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "425-698-1588",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "WA",
            "license": "MD60122545",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bellevue Legacy Primary Care PLLC
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• Bellevue Medical Imaging, PLLC
• Bellevue Neurology and Neuroscience PLLC
• Bellevue Neuromuscular Dentistry LLC
• Bellevue Optometry Clinic PS
• Bellevue Orthopedic Physicians PLLC
• Bellevue Pain and Wellness PLLC
• Bellevue Park Dental
• Bellevue Physiatry and Electrodiagnosis LLC

• Obstetrics & Gynecology Physician in Bellevue, WA
• Providers in Bellevue, WA by specialty
• Obstetrics & Gynecology Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.