Healthcare Provider Details

I. General information

NPI: 1396191680
Provider Name (Legal Business Name): STACEY CHEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2016
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 NE MOTHER JOSEPH PL STE 320
VANCOUVER WA
98664-3205
US

IV. Provider business mailing address

550 FIRST AVENUE NYU LANGONE MEDICAL CENTER
NEW YORK NY
10016
US

V. Phone/Fax

Practice location:
  • Phone: 360-514-6300
  • Fax: 360-514-6301
Mailing address:
  • Phone: 212-263-2225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number70147035
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: