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General NPI Number Information
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NPI Number | 1720111792
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Entity Type | Organization
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Legal Business Name | BELLEVUE INTERVENTIONAL SPINE SPECIALIST PS
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 05/08/2019
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Provider Practice Location Address
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Address Line | 13033 BEL RED RD SUITE 120
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City | BELLEVUE
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State | WA
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Zip | 98005-2622
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Country | US
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Telephone | 425-452-0101
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Fax |
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Provider Business Mailing Address
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Address Line | 13033 NE BEL RED RD STE 120
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City | BELLEVUE
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State | WA
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Zip | 98005-2633
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Country | US
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Telephone | 425-452-0101
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID H. CHANG
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Credential | M.D.
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Telephone | 425-452-0404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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