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General NPI Number Information
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NPI Number | 1164685632
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Entity Type | Individual
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Provider Name | MARK S FAN MD
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Gender | Male
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Dates
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Enumeration Date | 07/05/2008
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Last Update Date | 02/03/2021
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Provider Practice Location Address
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Address Line | 1515 116TH AVE NE STE 205
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City | BELLEVUE
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State | WA
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Zip | 98004-3811
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Country | US
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Telephone | 310-866-3707
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Fax | 425-999-4858
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Provider Business Mailing Address
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Address Line | PO BOX 741
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City | MERCER ISLAND
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State | WA
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Zip | 98040-0741
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Country | US
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Telephone |
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Fax | 425-999-4858
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MD60122545
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | A112478
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | NOT YET
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License Number State | NY
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