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NPI Code Detail

MEDICARE: DR. JASON PHEN DDS

MEDICARE: DR. JASON PHEN 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
1122300000XDentist110360CA

General Provider Information

NPI Number : 1376328146
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JASON PHEN DDS
Provider Business Mailing Address
First Line : PSC 475 BOX 1
Second Line :
City : FPO
State : AP
Zip : 96350-1200
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : PSC 475 BOX 1
Second Line :
City : FPO
State : AP
Zip : 96350-1200
Country : US
Telephone Number : 315-243-3260
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2023
Last Update Date : 03/29/2026

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Directions to “ DR. JASON PHEN DDS” Practice Location

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