Healthcare Provider Details

I. General information

NPI: 1538774815
Provider Name (Legal Business Name): MR. MING-CHIH LAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2020
Last Update Date: 09/13/2020
Certification Date: 09/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 141ST PL NE
BELLEVUE WA
98007-4040
US

IV. Provider business mailing address

1310 141ST PL NE
BELLEVUE WA
98007-4040
US

V. Phone/Fax

Practice location:
  • Phone: 206-306-5366
  • Fax:
Mailing address:
  • Phone: 206-306-5366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171R00000X
TaxonomyInterpreter
License NumberMC18112
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: