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1083654313

NPI Code Detail

MEDICARE: ELLEN H CHEN M.D.

MEDICARE: ELLEN H CHEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	MC-0231	ID
2	207RI0011X	Interventional Cardiology Physician	MC-0231	ID
3	207RI0011X	Interventional Cardiology Physician	MD00047746	WA
4	207RI0011X	Interventional Cardiology Physician	MED-PHYS-LIC-45806	MT
5	207RC0000X	Cardiovascular Disease Physician	MD186722	OR
6	207RC0000X	Cardiovascular Disease Physician	MD00047746	WA
7	207RC0000X	Cardiovascular Disease Physician	01077302A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000001041073	OTHER	IN	ANTHEM PROVIDER NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1015CH	OTHER	WA	REGENCE
4	8951017	OTHER	WA	CRIME VICTIMS
5	0248026	OTHER	WA	L&I
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083654313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN H CHEN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 59028
Second Line	:
City	:	RENTON
State	:	WA
Zip	:	98058-2028
Country	:	US
Telephone Number	:	425-656-5415
Fax Number	:	425-793-7458

Provider Business Practice Location Address
First Line	:	1775 THOMPSON RD
Second Line	:
City	:	COOS BAY
State	:	OR
Zip	:	97420-2198
Country	:	US
Telephone Number	:	541-269-8111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	03/24/2021

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Directions to “ ELLEN H CHEN M.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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