Provider Demographics
NPI:1295846012
Name:CHEN, JIM C (MD)
Entity Type:Individual
Prefix:DR
First Name:JIM
Middle Name:C
Last Name:CHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1 LAKE BELLEVUE DR
Mailing Address - Street 2:SUITE #101
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2417
Mailing Address - Country:US
Mailing Address - Phone:206-354-0603
Mailing Address - Fax:425-454-4556
Practice Address - Street 1:1 LAKE BELLEVUE DR
Practice Address - Street 2:SUITE #101
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2417
Practice Address - Country:US
Practice Address - Phone:206-354-0603
Practice Address - Fax:425-454-4556
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000316412084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8221277Medicaid
WA8221277Medicaid
WAAB02300Medicare ID - Type Unspecified