Provider Demographics
NPI:1992738918
Name:QUEEN ANNE OBSTETRICS AND GYNECOLOGY
Entity type:Organization
Organization Name:QUEEN ANNE OBSTETRICS AND GYNECOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:YUN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-781-1830
Mailing Address - Street 1:220 W MERCER ST STE 110
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-3954
Mailing Address - Country:US
Mailing Address - Phone:206-781-1830
Mailing Address - Fax:206-283-3640
Practice Address - Street 1:220 W MERCER ST STE 110
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-3954
Practice Address - Country:US
Practice Address - Phone:206-781-1830
Practice Address - Fax:206-283-3640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602256276207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7114788Medicaid
WA7114788Medicaid