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General NPI Number Information
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NPI Number | 1538606959
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Entity Type | Organization
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Legal Business Name | CHIAVEN PHENA PROF CORP
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Dates
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Enumeration Date | 01/24/2017
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Last Update Date | 01/24/2017
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Provider Practice Location Address
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Address Line | 8665 W FLAMINGO RD STE # 104
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City | LAS VEGAS
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State | NV
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Zip | 89147-8621
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Country | US
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Telephone | 702-982-0800
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Fax |
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Provider Business Mailing Address
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Address Line | 8665 W FLAMINGO RD STE # 104
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City | LAS VEGAS
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State | NV
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Zip | 89147-8621
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Country | US
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Telephone | 702-982-0800
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Fax |
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Authorized Official
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Title or Position | MANAGING DOCTOR
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Name | DR. HUAI PHEN
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Credential | DDS
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Telephone | 702-982-0800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 4640
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License Number State | NV
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