Healthcare Provider Details

I. General information

NPI: 1518325992
Provider Name (Legal Business Name): PETER CHEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2016
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3629 BELL BLVD STE 201
BAYSIDE NY
11361-2056
US

IV. Provider business mailing address

389 E 89TH ST APT 17G
NEW YORK NY
10128-5207
US

V. Phone/Fax

Practice location:
  • Phone: 917-740-5779
  • Fax:
Mailing address:
  • Phone: 347-728-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number059565
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: