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General NPI Number Information
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NPI Number | 1871778290
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Entity Type | Organization
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Legal Business Name | KENNETH G. CHEN D.D.S. INC.
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Dates
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Enumeration Date | 01/03/2008
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Last Update Date | 01/03/2008
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Provider Practice Location Address
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Address Line | 1001 W SAN MARCOS BLVD STE. 106C
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City | SAN MARCOS
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State | CA
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Zip | 92078-4012
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Country | US
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Telephone | 760-744-2168
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Fax | 760-744-0909
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Provider Business Mailing Address
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Address Line | 1001 W SAN MARCOS BLVD STE. 106C
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City | SAN MARCOS
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State | CA
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Zip | 92078-4012
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Country | US
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Telephone | 760-744-2168
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Fax | 760-744-0909
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KENNETH CHEN
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Credential | D.D.S.
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Telephone | 760-744-2168
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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 | 54522
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License Number State | CA
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