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General NPI Number Information
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NPI Number | 1720276397
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Entity Type | Organization
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Legal Business Name | HAI-SOU CHEN, DDS, A PROFESSIONAL CORP.
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Dates
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Enumeration Date | 10/09/2007
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Last Update Date | 10/09/2007
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Provider Practice Location Address
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Address Line | 301 W VALLEY BLVD STE 222
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City | SAN GABRIEL
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State | CA
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Zip | 91776-3759
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Country | US
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Telephone | 626-573-5637
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Fax | 626-308-9659
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Provider Business Mailing Address
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Address Line | 301 W VALLEY BLVD STE 222
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City | SAN GABRIEL
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State | CA
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Zip | 91776-3759
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Country | US
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Telephone | 626-573-5637
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Fax | 626-308-9659
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Authorized Official
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Title or Position | CEO
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Name | DR. HAI-SOU CHEN
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Credential | D.D.S.
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Telephone | 626-573-5637
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 29230
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License Number State | CA
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