Healthcare Provider Details

I. General information

NPI: 1801890538
Provider Name (Legal Business Name): DALI CHEN MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 12/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1628 S MILDRED ST STE 104
TACOMA WA
98465-1628
US

IV. Provider business mailing address

1628 S MILDRED ST STE 104
TACOMA WA
98465-1628
US

V. Phone/Fax

Practice location:
  • Phone: 253-565-6777
  • Fax: 253-565-8777
Mailing address:
  • Phone: 253-565-6777
  • Fax: 253-565-8777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD00034874
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: