Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DE60299028 | WA |
Y | 1223E0200X | Endodontist | DE60299028 | WA |
NPI | 1083962120 |
---|---|
Provider Name | Liang-Yu Chen |
First Address | Vancouver, WA 98683-1454 |
Second Address | Camas, WA 98607-8831 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2012 |
Last Update Date | 21/08/2012 |