Healthcare Provider Details

I. General information

NPI: 1457764052
Provider Name (Legal Business Name): XUN JOY CHEN DMD, MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JOY CHEN DMD, MD

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 12/15/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15005 SHADY GROVE RD STE 420
ROCKVILLE MD
20850-6321
US

IV. Provider business mailing address

15005 SHADY GROVE RD STE 420
ROCKVILLE MD
20850-6321
US

V. Phone/Fax

Practice location:
  • Phone: 301-762-0062
  • Fax:
Mailing address:
  • Phone: 301-762-0062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number17088
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD0089860
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: