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General NPI Number Information
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NPI Number | 1245443191
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Entity Type | Organization
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Legal Business Name | ELLAINE S. CHEN, D.D.S., INC
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 06/19/2008
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Provider Practice Location Address
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Address Line | 17980 CASTLETON ST SUITE #2
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City | CITY OF INDUSTRY
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State | CA
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Zip | 91748-1841
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Country | US
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Telephone | 626-965-6688
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Fax | 626-965-6680
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Provider Business Mailing Address
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Address Line | 3845 SYCAMORE ST
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City | WEST COVINA
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State | CA
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Zip | 91792-2763
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Country | US
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Telephone | 626-388-4457
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Fax | 626-965-6680
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ELLAINE S. CHEN
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Credential | D.D.S
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Telephone | 626-965-6688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 48367
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License Number State | CA
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