MEDICARE: FIDALAB

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1659837961
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIDALAB

Provider Business Mailing Address
First Line	:	1128 NW 52ND ST STE 401
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98107-5129
Country	:	US
Telephone Number	:	206-226-8960
Fax Number	:

Provider Business Practice Location Address
First Line	:	1128 NW 52ND ST STE 401
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98107-5129
Country	:	US
Telephone Number	:	425-559-0680
Fax Number	:

Authorized Official
Title or Position	:	CHIEF OF SCIENTIFIC OFFICER
Name	:	QINGHUA QUINNE FENG
Credential	:	PHD
Telephone Number	:	206-245-6349

Provider Enumeration Date	:	02/12/2019
Last Update Date	:	06/09/2023

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Directions to “FIDALAB ” Practice Location

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