Healthcare Provider Details

I. General information

NPI: 1992057202
Provider Name (Legal Business Name): GRACE CHEN NOH D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. GRACE CHEN

II. Dates (important events)

Enumeration Date: 10/10/2012
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20370 TRAILS END RD
WALNUT CA
91789-1837
US

IV. Provider business mailing address

20370 TRAILS END RD
WALNUT CA
91789-1837
US

V. Phone/Fax

Practice location:
  • Phone: 862-754-6063
  • Fax:
Mailing address:
  • Phone: 862-754-6063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number104925
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: