Provider Demographics
NPI:1538351192
Name:CHEN, JARVIS CHUNG (MD)
Entity type:Individual
Prefix:DR
First Name:JARVIS
Middle Name:CHUNG
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 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 STE 100
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-1900
Practice Address - Country:US
Practice Address - Phone:253-761-4200
Practice Address - Fax:253-761-4201
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000480662085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8871919OtherPTAN-TRA PIERCE CO
WA0238323OtherLABOR AND INDUSTRIES-UNION AVENUE OPEN MRI
WA8947517OtherLABOR AND INDUSTRIES CRIME VICTIMS-TRA
WA0236602OtherLABOR AND INDUSTRIES-TRA
WA1089419Medicaid
WA8947516OtherLABOR AND INDUSTRIES CRIME VICTIMS-UNION AVENUE OPEN MRI
WA0249539OtherLABOR AND INDUSTRIES-MEDICAL IMAGING ON 1ST
WA0238323OtherLABOR AND INDUSTRIES-UNION AVENUE OPEN MRI
WA8947517OtherLABOR AND INDUSTRIES CRIME VICTIMS-TRA