Healthcare Provider Details

I. General information

NPI: 1104851062
Provider Name (Legal Business Name): CHRISTY Y. CHEN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 W MISSION AVE SUITE V
ESCONDIDO CA
92025-1733
US

IV. Provider business mailing address

4653 CARMEL MOUNTAIN ROAD SUITE 306
SAN DIEGO CA
92130
US

V. Phone/Fax

Practice location:
  • Phone: 760-489-2600
  • Fax: 760-301-8007
Mailing address:
  • Phone: 858-350-0045
  • Fax: 858-228-4367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number43914
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: