Provider Demographics
NPI:1447548003
Name:BELLEVUE WOMEN'S CLINIC PLLC
Entity type:Organization
Organization Name:BELLEVUE WOMEN'S CLINIC PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MABEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:OBENG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-417-2968
Mailing Address - Street 1:7904 110TH AVE SE APT 207
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98056-1684
Mailing Address - Country:US
Mailing Address - Phone:425-998-3474
Mailing Address - Fax:
Practice Address - Street 1:22500 SE 64TH PL
Practice Address - Street 2:SUITE 120
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-8111
Practice Address - Country:US
Practice Address - Phone:425-998-3474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60141544207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty