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General NPI Number Information
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NPI Number | 1295163673
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Entity Type | Organization
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Legal Business Name | GRACE CHEN DDS LLC
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Dates
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Enumeration Date | 10/23/2013
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Last Update Date | 10/23/2013
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Provider Practice Location Address
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Address Line | 1234 KILAUEA AVE
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City | HILO
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State | HI
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Zip | 96720-4282
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Country | US
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Telephone | 808-961-5766
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Fax | 808-935-5985
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Provider Business Mailing Address
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Address Line | 1234 KILAUEA AVE
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City | HILO
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State | HI
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Zip | 96720-4282
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Country | US
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Telephone | 808-961-5766
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Fax | 808-935-5985
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. GRACE CHEN
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Credential | DDS MS
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Telephone | 808-961-5766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DT 2308
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License Number State | HI
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