Provider Demographics
NPI:1982045084
Name:BELLEVUE LASER AND COSMETIC CENTER
Entity Type:Organization
Organization Name:BELLEVUE LASER AND COSMETIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHIU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-732-2677
Mailing Address - Street 1:1200 112TH AVE NE
Mailing Address - Street 2:SUITE C-187
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3732
Mailing Address - Country:US
Mailing Address - Phone:425-732-2677
Mailing Address - Fax:425-457-7499
Practice Address - Street 1:1200 112TH AVE NE
Practice Address - Street 2:SUITE C-187
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3732
Practice Address - Country:US
Practice Address - Phone:425-732-2677
Practice Address - Fax:425-457-7499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-17
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000043597207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty