Healthcare Provider Details

I. General information

NPI: 1861260903
Provider Name (Legal Business Name): J CHEN DDS DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2023
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5512 E BRITTON DR STE 204
LONG BEACH CA
90815-3150
US

IV. Provider business mailing address

6140 E SANTA ANA CANYON RD
ANAHEIM CA
92807-2302
US

V. Phone/Fax

Practice location:
  • Phone: 562-493-0693
  • Fax: 562-431-8402
Mailing address:
  • Phone: 714-932-1117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH CHEN
Title or Position: OWNER
Credential: DDS
Phone: 714-932-1117