Provider Demographics
NPI:1144333212
Name:BELLEVUE INTERVENTIONAL SPINE SPECIALIST PS
Entity type:Organization
Organization Name:BELLEVUE INTERVENTIONAL SPINE SPECIALIST PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:425-452-0101
Mailing Address - Street 1:13033 BEL RED RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2622
Mailing Address - Country:US
Mailing Address - Phone:425-452-0101
Mailing Address - Fax:425-452-0303
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:425-452-0303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00032734174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB25963Medicare PIN