Provider Demographics
NPI:1679509616
Name:CHEN, TIMOTHY T (DO)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:T
Last Name:CHEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 S ZINTEL WAY
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338
Mailing Address - Country:US
Mailing Address - Phone:509-942-3627
Mailing Address - Fax:509-942-2268
Practice Address - Street 1:1100 GOETHALS DR
Practice Address - Street 2:KADLEC INLAND CARDIOLOGY
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3304
Practice Address - Country:US
Practice Address - Phone:509-946-2699
Practice Address - Fax:509-946-2675
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001085207RC0000X
ORD015794207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1679509616Medicaid
WA312200OtherL&I
OR009287Medicaid
WAP060040166OtherMEDICARE RR
WA312200OtherL&I