Provider Demographics
NPI:1023187622
Name:CHEN, I JEN (MD)
Entity Type:Individual
Prefix:MR
First Name:I JEN
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10317 GREENWOOD AVENUE N
Mailing Address - Street 2:#202
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-9152
Mailing Address - Country:US
Mailing Address - Phone:206-297-6056
Mailing Address - Fax:206-297-6059
Practice Address - Street 1:10317 GREENWOOD AVENUE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-9152
Practice Address - Country:US
Practice Address - Phone:206-297-6056
Practice Address - Fax:206-297-6059
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00022361207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1017870Medicaid
A06070Medicare UPIN
000106269Medicare ID - Type Unspecified