Healthcare Provider Details

I. General information

NPI: 1477512598
Provider Name (Legal Business Name): HESHUN SHAWN CHEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2610 S SENECA ST STE 104
WICHITA KS
67217-2860
US

IV. Provider business mailing address

230 N FIDDLERS CREEK ST
VALLEY CENTER KS
67147-4002
US

V. Phone/Fax

Practice location:
  • Phone: 316-262-1911
  • Fax: 316-262-5005
Mailing address:
  • Phone: 509-460-1569
  • Fax: 316-262-5005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE00009581
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2007033356
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number60881
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: