Provider Demographics
NPI:1730280124
Name:CHEN, JOHN C (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:CHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8659 INVERNESS DR NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-3987
Mailing Address - Country:US
Mailing Address - Phone:206-522-6047
Mailing Address - Fax:206-523-9383
Practice Address - Street 1:8659 INVERNESS DR NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-3987
Practice Address - Country:US
Practice Address - Phone:206-522-6047
Practice Address - Fax:206-523-9383
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00035600207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00092319OtherRAILROAD
WA129288OtherLABOR & INDUSTRY
WA1109529Medicaid
WAG60056Medicare UPIN
WA1109529Medicaid