Provider Demographics
NPI:1003416454
Name:FAN, HSINYUAN (DDS, MDS, MS)
Entity Type:Individual
Prefix:DR
First Name:HSINYUAN
Middle Name:
Last Name:FAN
Suffix:
Gender:F
Credentials:DDS, MDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 108TH AVE NE STE 1710
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-5598
Mailing Address - Country:US
Mailing Address - Phone:888-490-1421
Mailing Address - Fax:
Practice Address - Street 1:500 108TH AVE NE STE 1710
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-5598
Practice Address - Country:US
Practice Address - Phone:888-490-1421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE611097341223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics