Provider Demographics
NPI:1063059046
Name:CHEN, JIAYI (LMT)
Entity type:Individual
Prefix:
First Name:JIAYI
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15935 NE 8TH ST STE A104
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-3918
Mailing Address - Country:US
Mailing Address - Phone:425-246-1938
Mailing Address - Fax:
Practice Address - Street 1:15935 NE 8TH ST STE A104
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98008-3918
Practice Address - Country:US
Practice Address - Phone:425-246-1938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60936048225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist