Provider Demographics
NPI:1982874970
Name:CHEN, XIAOMING (MD, PHD)
Entity Type:Individual
Prefix:
First Name:XIAOMING
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:MD, PHD
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 1535
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98401-1535
Mailing Address - Country:US
Mailing Address - Phone:253-761-4200
Mailing Address - Fax:253-383-3553
Practice Address - Street 1:1304 FAWCETT AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-1911
Practice Address - Country:US
Practice Address - Phone:253-761-4200
Practice Address - Fax:253-383-3553
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2017-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000390012085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8949628OtherLABOR AND INDUSTRIES CRIME VICTIMS-CAROL MILGARD BREAST CENTER
WA8951838OtherLABOR AND INDUSTRIES CRIME VICTIMS-MEDICAL IMAGING ON 1ST
WAG8927632OtherPTAN-UAOM
WA0230293OtherLABOR AND INDUSTRIES-TRA
WA0249535OtherLABOR AND INDUSTRIES-MEDICAL IMAGING ON 1ST
WAG8878589OtherPTAN-CMBC
WAP00689880OtherRR MEDICARE-CAROL MILGARD BREAST CENTER
WA0243532OtherLABOR AND INDUSTRIES-CAROL MILGARD BREAST CENTER
WA8946791OtherLABOR AND INDUSTRIES CRIME VICTIMS-TRA
WA8871251OtherPTAN-TRA KING CO
WA8871252OtherPTAN-TRA PIERCE CO
WA8946794OtherLABOR AND INDUSTRIES CRIME VICTIMS-UNION AVENUE OPEN MRI
WA0230290OtherLABOR AND INDUSTRIES-UAOM
WAG8882927OtherPTAN-MIO1
WAH54406Medicare UPIN