Healthcare Provider Details

I. General information

NPI: 1871203307
Provider Name (Legal Business Name): CHIH HUA CHEN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2022
Last Update Date: 11/23/2022
Certification Date: 11/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 BARBER CT
MILPITAS CA
95035-7915
US

IV. Provider business mailing address

1855 CAMARGO DR
SAN JOSE CA
95132-1610
US

V. Phone/Fax

Practice location:
  • Phone: 571-346-0155
  • Fax:
Mailing address:
  • Phone: 571-346-0155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS107981
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS107981
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: