Provider Demographics
NPI:1083654313
Name:CHEN, ELLEN H (MD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:H
Last Name:CHEN
Suffix:
Gender:F
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:PO BOX 59028
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-2028
Mailing Address - Country:US
Mailing Address - Phone:425-656-5415
Mailing Address - Fax:425-793-7458
Practice Address - Street 1:1775 THOMPSON RD
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2198
Practice Address - Country:US
Practice Address - Phone:541-269-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMC-0231207RC0000X, 207RI0011X
WAMD00047746207RI0011X, 207RC0000X
MTMED-PHYS-LIC-45806207RI0011X
ORMD186722207RC0000X
IN01077302A207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000001041073OtherANTHEM PROVIDER NUMBER
IN201379160Medicaid
WA1015CHOtherREGENCE
WA8951017OtherCRIME VICTIMS
WA0248026OtherL&I
WA8478695Medicaid
WAP00759634Medicare PIN
INP01811891Medicare PIN
IN815500172Medicare UPIN
WAG8880484Medicare PIN