Healthcare Provider Details

I. General information

NPI: 1053510370
Provider Name (Legal Business Name): GRACE CHEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 07/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3303 SW BOND AVE
PORTLAND OR
97239-4501
US

IV. Provider business mailing address

3303 SW BOND AVE
PORTLAND OR
97239-4501
US

V. Phone/Fax

Practice location:
  • Phone: 503-494-9000
  • Fax: 503-494-1760
Mailing address:
  • Phone: 503-494-9000
  • Fax: 503-494-1760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD25304
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: