Healthcare Provider Details

I. General information

NPI: 1487586673
Provider Name (Legal Business Name): JOANNA CHEN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11130 FAIRFAX BLVD STE 201
FAIRFAX VA
22030-5035
US

IV. Provider business mailing address

2952 EMERALD CHASE DR
HERNDON VA
20171-2320
US

V. Phone/Fax

Practice location:
  • Phone: 703-591-1007
  • Fax:
Mailing address:
  • Phone: 703-889-0366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401420060
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: