Provider Demographics
NPI:1720111792
Name:BELLEVUE INTERVENTIONAL SPINE SPECIALIST PS
Entity Type:Organization
Organization Name:BELLEVUE INTERVENTIONAL SPINE SPECIALIST PS
Other - Org Name:BELLEVUE SPINE SPECIALIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-452-0404
Mailing Address - Street 1:13033 NE BEL RED RD STE 120
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2633
Mailing Address - Country:US
Mailing Address - Phone:425-452-0101
Mailing Address - Fax:
Practice Address - Street 1:13033 BEL RED RD
Practice Address - Street 2:SUITE 120
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2622
Practice Address - Country:US
Practice Address - Phone:425-452-0101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8865568Medicare PIN