=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841212461
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHUN YU YOGI CHEN DMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2006
-----------------------------------------------------
Last Update Date | 11/28/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10830 W CHARLESTON BLVD STE 130
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89135-1194
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-268-7132
-----------------------------------------------------
Fax | 725-201-0469
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3896 N MLK BLVD
-----------------------------------------------------
City | NORTH LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89032-6603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-904-8670
-----------------------------------------------------
Fax | 702-933-0190
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 18640
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | S3177
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------