Healthcare Provider Details

I. General information

NPI: 1760736243
Provider Name (Legal Business Name): GRACE CHEN DDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2012
Last Update Date: 11/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 KAPIOLANI BLVD STE 712
HONOLULU HI
96814-4404
US

IV. Provider business mailing address

1441 KAPIOLANI BLVD STE 712
HONOLULU HI
96814
US

V. Phone/Fax

Practice location:
  • Phone: 808-744-4433
  • Fax:
Mailing address:
  • Phone: 808-744-4433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDT2308
License Number StateHI

VIII. Authorized Official

Name: MR. BING CDHEN
Title or Position: CEO
Credential:
Phone: 720-933-3130