Provider Demographics
NPI:1306906722
Name:CHEN, BENSON (MD)
Entity type:Individual
Prefix:DR
First Name:BENSON
Middle Name:
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 1:12600 SE 38TH ST
Mailing Address - Street 2:#108
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-6105
Mailing Address - Country:US
Mailing Address - Phone:425-298-5005
Mailing Address - Fax:
Practice Address - Street 1:12600 SE 38TH ST
Practice Address - Street 2:#108
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-6105
Practice Address - Country:US
Practice Address - Phone:425-298-5005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00047239207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1306906722OtherNPI
WA2000274Medicaid