Provider Demographics
NPI:1417957515
Name:CHERN, SANDRA (MD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:CHERN
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 1:317 N DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7750
Mailing Address - Country:US
Mailing Address - Phone:509-736-5550
Mailing Address - Fax:509-737-8281
Practice Address - Street 1:317 N DELAWARE ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7750
Practice Address - Country:US
Practice Address - Phone:509-736-5550
Practice Address - Fax:509-737-8281
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60576024207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD60576024OtherMEDICAL LICENSE
IN180040621OtherMEDICARE RAILROAD
F72289Medicare UPIN
WAG8942402Medicare PIN
IN180040621OtherMEDICARE RAILROAD
IN165380AMedicare PIN