Healthcare Provider Details

I. General information

NPI: 1093342271
Provider Name (Legal Business Name): EUNICE FAITH HSU FAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EUNICE FAITH HSU FAN MD

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 STATE AVE N STE 220
KENT WA
98030-4543
US

IV. Provider business mailing address

219 STATE AVE N STE 220
KENT WA
98030-4543
US

V. Phone/Fax

Practice location:
  • Phone: 253-372-7866
  • Fax:
Mailing address:
  • Phone: 253-372-7866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number61549336
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberU0595
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: