Healthcare Provider Details

I. General information

NPI: 1114031655
Provider Name (Legal Business Name): CHIA-JEN KUAN M.D., PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 02/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 PACIFIC AVE SUITE B
EVERETT WA
98201-4032
US

IV. Provider business mailing address

1111 PACIFIC AVE SUITE B
EVERETT WA
98201-4200
US

V. Phone/Fax

Practice location:
  • Phone: 425-257-1100
  • Fax: 425-257-1106
Mailing address:
  • Phone: 425-257-1100
  • Fax: 425-257-1106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD00031127
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: