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General NPI Number Information
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NPI Number | 1679095137
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Entity Type | Individual
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Provider Name | JIMMIE CHEN DMD
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Gender | Male
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Dates
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Enumeration Date | 07/16/2017
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Last Update Date | 11/26/2023
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Provider Practice Location Address
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Address Line | 4213 BURNET RD STE B
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City | AUSTIN
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State | TX
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Zip | 78756-3316
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Country | US
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Telephone | 512-454-9691
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Fax |
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Provider Business Mailing Address
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Address Line | 804 BROWN DR
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City | PFLUGERVILLE
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State | TX
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Zip | 78660-4761
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Country | US
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Telephone | 832-866-3363
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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 | 33263
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License Number State | TX
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