Provider Demographics
NPI:1487638334
Name:CHEN, PETER Y (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:Y
Last Name:CHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:YIPING
Other - Middle Name:
Other - Last Name:CHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1901 SOUTH CEDAR ST
Mailing Address - Street 2:SUITE #301 CARDIAC STUDY CENTER INC PS
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405
Mailing Address - Country:US
Mailing Address - Phone:253-572-7320
Mailing Address - Fax:253-627-3191
Practice Address - Street 1:1901 SOUTH CEDAR
Practice Address - Street 2:#301 CARDIAC STUDY CENTER INC PS
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405
Practice Address - Country:US
Practice Address - Phone:253-572-7320
Practice Address - Fax:253-627-3191
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00043318207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8383713Medicaid
WA8383713Medicaid
WAG8801558Medicare ID - Type Unspecified