Provider Demographics
NPI:1801146600
Name:CHEN, SAMANTHA RAE (EAMP)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:RAE
Last Name:CHEN
Suffix:
Gender:F
Credentials:EAMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13812 SE 1ST ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-3704
Mailing Address - Country:US
Mailing Address - Phone:425-643-9395
Mailing Address - Fax:425-643-9395
Practice Address - Street 1:13812 SE 1ST ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-3704
Practice Address - Country:US
Practice Address - Phone:425-643-9395
Practice Address - Fax:425-643-9395
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60299093171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist