Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DE61109734 | WA |
NPI | 1003416454 |
---|---|
Provider Name | Dr. Hsinyuan Fan |
First Address | Bellevue, WA 98004-5598 |
Second Address | Bellevue, WA 98004-5598 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2020 |
Last Update Date | 27/10/2020 |