Provider Demographics
NPI:1114031655
Name:KUAN, CHIA-JEN (MD, PHD)
Entity Type:Individual
Prefix:
First Name:CHIA-JEN
Middle Name:
Last Name:KUAN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 PACIFIC AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-4200
Mailing Address - Country:US
Mailing Address - Phone:425-257-1100
Mailing Address - Fax:425-257-1106
Practice Address - Street 1:1111 PACIFIC AVE
Practice Address - Street 2:SUITE B
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4032
Practice Address - Country:US
Practice Address - Phone:425-257-1100
Practice Address - Fax:425-257-1106
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00031127207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA912171951OtherTAX ID
WA1114883Medicaid
WA912171951OtherTAX ID
WA1114883Medicaid