Provider Demographics
NPI:1982045084
Name:BELLEVUE LASER AND COSMETIC CENTER PS
Entity type:Organization
Organization Name:BELLEVUE LASER AND COSMETIC CENTER PS
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 STE C240
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3747
Mailing Address - Country:US
Mailing Address - Phone:425-732-2677
Mailing Address - Fax:425-457-7499
Practice Address - Street 1:1200 112TH AVE NE STE C240
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3747
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:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000043597207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty