Healthcare Provider Details

I. General information

NPI: 1972339877
Provider Name (Legal Business Name): PACIFIC NW FERTILITY AND IVF SPECIALISTS. I. PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1231 116TH AVE NE STE 750
BELLEVUE WA
98004-3812
US

IV. Provider business mailing address

1101 MADISON ST STE 1050
SEATTLE WA
98104-3558
US

V. Phone/Fax

Practice location:
  • Phone: 206-515-0000
  • Fax:
Mailing address:
  • Phone: 206-515-0000
  • Fax: 206-515-0001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA0006X
TaxonomyAmbulatory Fertility Facility
License Number
License Number State

VIII. Authorized Official

Name: MEY SAECHAO
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 206-515-0054