Healthcare Provider Details

I. General information

NPI: 1063086171
Provider Name (Legal Business Name): CARRIE CHEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2021
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 E VINEYARD AVE
OXNARD CA
93036-1615
US

IV. Provider business mailing address

1104 FUHRMAN RD
CINCINNATI OH
45215-4018
US

V. Phone/Fax

Practice location:
  • Phone: 805-436-3444
  • Fax: 805-485-4160
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS108273
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30.026481
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: