Healthcare Provider Details

I. General information

NPI: 1558610584
Provider Name (Legal Business Name): CHAO SHEN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2012
Last Update Date: 01/16/2023
Certification Date: 01/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 SE 117TH AVE STE 110
VANCOUVER WA
98683-5297
US

IV. Provider business mailing address

601 SE 117TH AVE STE 110
VANCOUVER WA
98683-5297
US

V. Phone/Fax

Practice location:
  • Phone: 503-334-4400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE60308272
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD10723
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberD10723
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDE60308272
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: