=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316938525
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID H CHEN DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/04/2005
-----------------------------------------------------
Last Update Date | 04/29/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11817 98TH AVE NE
-----------------------------------------------------
City | KIRKLAND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98034-4214
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-284-4455
-----------------------------------------------------
Fax | 425-284-4451
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11817 98TH AVE NE
-----------------------------------------------------
City | KIRKLAND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98034-4214
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-284-4455
-----------------------------------------------------
Fax | 425-284-4451
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DE00009454
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------