Healthcare Provider Details

I. General information

NPI: 1659295616
Provider Name (Legal Business Name): JIAHAO CHEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10002 NE 13TH AVE STE 107
VANCOUVER WA
98686-5507
US

IV. Provider business mailing address

6804 NE 28TH AVE
VANCOUVER WA
98665-0727
US

V. Phone/Fax

Practice location:
  • Phone: 360-553-1068
  • Fax: 360-583-3500
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA70139298
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: