MEDICARE: KENNETH CHEN DO, PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	61167052	WA
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1558985549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH CHEN DO, PHD

Provider Business Mailing Address
First Line	:	1959 NE PACIFIC ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98195-0001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1959 NE PACIFIC ST # NW120
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98195-1610
Country	:	US
Telephone Number	:	206-598-8458
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2020
Last Update Date	:	09/16/2024

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