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General NPI Number Information
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NPI Number | 1922359603
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Entity Type | Organization
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Legal Business Name | SOFISE CHEN, D.D.S. A PROFESSIONAL DENTAL CORPORATION
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Dates
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Enumeration Date | 09/21/2012
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Last Update Date | 10/17/2012
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Provider Practice Location Address
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Address Line | 2625 W ALAMEDA AVE 216
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City | BURBANK
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State | CA
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Zip | 91505-4806
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Country | US
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Telephone | 818-846-8564
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Fax |
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Provider Business Mailing Address
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Address Line | 6218 CAMELLIA AVE
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City | TEMPLE CITY
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State | CA
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Zip | 91780-1758
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Country | US
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Telephone | 626-623-8118
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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. SOFISE CHEN
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Credential | D.D.S.
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Telephone | 626-623-8118
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 41595
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License Number State | CA
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