Provider Demographics
NPI:1962449090
Name:CHEN, STAN SU-TAH (MD)
Entity Type:Individual
Prefix:
First Name:STAN
Middle Name:SU-TAH
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:PO BOX 24801
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-0801
Mailing Address - Country:US
Mailing Address - Phone:425-407-1500
Mailing Address - Fax:425-407-1112
Practice Address - Street 1:625 9TH AVE STE 150
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2467
Practice Address - Country:US
Practice Address - Phone:360-442-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD25812207L00000X
WAMD00035720207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2034890Medicaid
OR135106Medicaid
ORR131882Medicare ID - Type Unspecified
WAG8957791Medicare UPIN
WA2034890Medicaid