MEDICARE: JASON CHEN

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	390200000X	Student in an Organized Health Care Education/Training Program
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	064850	NY

General Provider Information

NPI Number	:	1871174532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON CHEN

Provider Business Mailing Address
First Line	:	71 UDALL DR
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11020-1529
Country	:	US
Telephone Number	:	646-734-0592
Fax Number	:

Provider Business Practice Location Address
First Line	:	3530 FRANCIS LEWIS BLVD STE 205
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11358-1959
Country	:	US
Telephone Number	:	718-762-2340
Fax Number	:

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

Provider Enumeration Date	:	04/15/2021
Last Update Date	:	07/28/2025

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Directions to “ JASON CHEN ” Practice Location

Language	Start Address	Practice Location

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