Healthcare Provider Details

I. General information

NPI: 1568815330
Provider Name (Legal Business Name): CHEN-CHEN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2016
Last Update Date: 07/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 S RENTON VILLAGE PL STE 610
RENTON WA
98057-3287
US

IV. Provider business mailing address

555 S RENTON VILLAGE PL STE 610
RENTON WA
98057-3287
US

V. Phone/Fax

Practice location:
  • Phone: 425-271-5812
  • Fax: 425-226-7448
Mailing address:
  • Phone: 425-271-5812
  • Fax: 425-226-7448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number7759
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDE00007986
License Number StateWA

VIII. Authorized Official

Name: ALLEN CHEN
Title or Position: OWNER
Credential:
Phone: 425-271-5812