MEDICARE: TOM T.P. CHEN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	26967	CA

General Provider Information

NPI Number	:	1114021565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TOM T.P. CHEN DDS

Provider Business Mailing Address
First Line	:	16900 GOLDENWEST ST
Second Line	:	STE. A
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-8405
Country	:	US
Telephone Number	:	714-375-2436
Fax Number	:

Provider Business Practice Location Address
First Line	:	16900 GOLDENWEST ST
Second Line	:	STE. A
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-8405
Country	:	US
Telephone Number	:	714-375-2436
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	07/08/2007

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