Provider Demographics
NPI:1659837961
Name:FIDALAB
Entity Type:Organization
Organization Name:FIDALAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF SCIENTIFIC OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:QINGHUA
Authorized Official - Middle Name:QUINNE
Authorized Official - Last Name:FENG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:206-245-6349
Mailing Address - Street 1:1128 NW 52ND ST STE 401
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-5129
Mailing Address - Country:US
Mailing Address - Phone:206-226-8960
Mailing Address - Fax:
Practice Address - Street 1:1128 NW 52ND ST STE 401
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-5129
Practice Address - Country:US
Practice Address - Phone:425-559-0680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-12
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory