Healthcare Provider Details

I. General information

NPI: 1548197999
Provider Name (Legal Business Name): ERIC CHEN DDS, MS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1472 SILVER LAKE BLVD
LOS ANGELES CA
90026-1346
US

IV. Provider business mailing address

1472 SILVER LAKE BLVD
LOS ANGELES CA
90026-1346
US

V. Phone/Fax

Practice location:
  • Phone: 310-405-3155
  • Fax:
Mailing address:
  • Phone: 310-405-3155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIC CHEN
Title or Position: OWNER
Credential: DDS, MS
Phone: 310-405-3155