Healthcare Provider Details

I. General information

NPI: 1730700741
Provider Name (Legal Business Name): CHRISTIAN VAN ROOYEN MB CHB
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2020
Last Update Date: 04/05/2022
Certification Date: 04/05/2022
Deactivation Date: 01/11/2022
Reactivation Date: 03/28/2022

III. Provider practice location address

1951 PACIFIC STREET
SEATTLE WA
98195
US

IV. Provider business mailing address

1951 PACIFIC STREET BOX 356540
SEATTLE WA
98195
US

V. Phone/Fax

Practice location:
  • Phone: 206-543-2474
  • Fax:
Mailing address:
  • Phone: 206-543-2474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: