Healthcare Provider Details

I. General information

NPI: 1841212461
Provider Name (Legal Business Name): CHUN YU YOGI CHEN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 11/28/2023
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10830 W CHARLESTON BLVD STE 130
LAS VEGAS NV
89135-1194
US

IV. Provider business mailing address

3896 N MLK BLVD
NORTH LAS VEGAS NV
89032-6603
US

V. Phone/Fax

Practice location:
  • Phone: 702-268-7132
  • Fax: 725-201-0469
Mailing address:
  • Phone: 508-904-8670
  • Fax: 702-933-0190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number18640
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberS3177
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: