Healthcare Provider Details

I. General information

NPI: 1942947395
Provider Name (Legal Business Name): KEVIN CHEN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2022
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

454 E CALAVERAS BLVD
MILPITAS CA
95035-5412
US

IV. Provider business mailing address

370 23RD AVE APT 6
SAN FRANCISCO CA
94121-2051
US

V. Phone/Fax

Practice location:
  • Phone: 408-263-6694
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDDS112523
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: