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General NPI Number Information
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NPI Number | 1558050294
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Entity Type | Individual
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Provider Name | SOPHIA CHEN
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Gender | Female
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Dates
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Enumeration Date | 05/08/2023
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Last Update Date | 12/16/2024
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Provider Practice Location Address
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Address Line | 299 W 12TH ST APT 1AB
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City | NEW YORK
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State | NY
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Zip | 10014-1834
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Country | US
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Telephone | 212-242-9098
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Fax |
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Provider Business Mailing Address
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Address Line | 56 7TH AVE APT 3A
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City | NEW YORK
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State | NY
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Zip | 10011-6652
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Country | US
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Telephone | 267-335-7132
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 064288
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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