Healthcare Provider Details

I. General information

NPI: 1114381720
Provider Name (Legal Business Name): MEI-JEN CHEN D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL CHEN

II. Dates (important events)

Enumeration Date: 04/09/2016
Last Update Date: 04/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8012 112TH STREET CT E #320
PUYALLUP WA
98373-7856
US

IV. Provider business mailing address

4688 KINGSWAY APT 703
BURNABY BC
V5H0E9
CA

V. Phone/Fax

Practice location:
  • Phone: 253-848-2331
  • Fax:
Mailing address:
  • Phone: 414-502-6267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE 60581683
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: