Provider Demographics
NPI:1477512598
Name:CHEN, HESHUN SHAWN (DDS)
Entity Type:Individual
Prefix:
First Name:HESHUN
Middle Name:SHAWN
Last Name:CHEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 N FIDDLERS CREEK ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY CENTER
Mailing Address - State:KS
Mailing Address - Zip Code:67147-4002
Mailing Address - Country:US
Mailing Address - Phone:509-460-1569
Mailing Address - Fax:316-262-5005
Practice Address - Street 1:2610 S SENECA ST STE 104
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67217-2860
Practice Address - Country:US
Practice Address - Phone:316-262-1911
Practice Address - Fax:316-262-5005
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000095811223G0001X
MO20070333561223G0001X
KS608811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5048145Medicaid