Healthcare Provider Details

I. General information

NPI: 1225615958
Provider Name (Legal Business Name): CYNTHIA X CHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2021
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 16TH AVE E
SEATTLE WA
98112-5226
US

IV. Provider business mailing address

201 16TH AVE E
SEATTLE WA
98112-5226
US

V. Phone/Fax

Practice location:
  • Phone: 206-326-3000
  • Fax: 877-515-2975
Mailing address:
  • Phone: 206-326-3000
  • Fax: 877-515-2975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD.MD.70128628
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: