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General NPI Number Information
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NPI Number | 1861769820
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Entity Type | Organization
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Legal Business Name | I. J. CHEN, D.D.S., DENTAL CORPORATION
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Dates
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Enumeration Date | 11/18/2011
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Last Update Date | 11/18/2011
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Provider Practice Location Address
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Address Line | 1107 E LAS TUNAS DR
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City | SAN GABRIEL
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State | CA
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Zip | 91776-1701
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Country | US
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Telephone | 626-285-0031
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Fax |
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Provider Business Mailing Address
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Address Line | 1107 E LAS TUNAS DR
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City | SAN GABRIEL
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State | CA
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Zip | 91776-1701
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ISAAC CHEN
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Credential |
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Telephone | 626-285-0031
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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 | 36069
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License Number State | CA
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