Healthcare Provider Details

I. General information

NPI: 1417675620
Provider Name (Legal Business Name): LUISITO HUANG CHEN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

972 GOODRICH BLVD
COMMERCE CA
90022-4114
US

IV. Provider business mailing address

8627 ATLANTIC AVE
SOUTH GATE CA
90280-3501
US

V. Phone/Fax

Practice location:
  • Phone: 888-499-9303
  • Fax:
Mailing address:
  • Phone: 888-499-9303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number107685
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: