Healthcare Provider Details

I. General information

NPI: 1972690071
Provider Name (Legal Business Name): JONATHAN CHEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 07/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SAND POINT WAY NE 2.820
SEATTLE WA
98105-3901
US

IV. Provider business mailing address

4800 SAND POINT WAY NE 2.820
SEATTLE WA
98105-3901
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-5759
  • Fax: 206-987-3839
Mailing address:
  • Phone: 206-987-5159
  • Fax: 206-987-3839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD60351835
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberMD60351835
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: