Healthcare Provider Details

I. General information

NPI: 1942368410
Provider Name (Legal Business Name): JAMES CHEN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 08/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4632 RIVERSIDE DR
CHINO CA
91710-3926
US

IV. Provider business mailing address

4632 RIVERSIDE DR
CHINO CA
91710-3926
US

V. Phone/Fax

Practice location:
  • Phone: 909-517-0088
  • Fax: 909-517-3939
Mailing address:
  • Phone: 909-517-0088
  • Fax: 909-517-3939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number44850
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: