Healthcare Provider Details

I. General information

NPI: 1851055511
Provider Name (Legal Business Name): JUSTIN CHEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2021
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4570 KLAHANIE DR SE
SAMMAMISH WA
98029-5812
US

IV. Provider business mailing address

4301 NE 3RD CT
RENTON WA
98059-5292
US

V. Phone/Fax

Practice location:
  • Phone: 425-392-8551
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPH61073116
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: