Healthcare Provider Details

I. General information

NPI: 1841498003
Provider Name (Legal Business Name): VIVIANE M BUNIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 03/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14100 SE 36TH ST STE 105
BELLEVUE WA
98006-1657
US

IV. Provider business mailing address

14100 SE 36TH ST STE 105
BELLEVUE WA
98006-1657
US

V. Phone/Fax

Practice location:
  • Phone: 425-502-8772
  • Fax: 425-698-1279
Mailing address:
  • Phone: 425-502-8772
  • Fax: 425-698-1279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberA120983
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number51233
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberP5518
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: