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General NPI Number Information
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NPI Number | 1972798528
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Entity Type | Individual
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Provider Name | JAE MIN CHAE DMD
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Gender | Male
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Dates
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Enumeration Date | 09/07/2007
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Last Update Date | 07/05/2012
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Provider Practice Location Address
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Address Line | 1100 WASHINGTON AVE LOT C
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City | PHILADELPHIA
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State | PA
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Zip | 19147-3821
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Country | US
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Telephone | 215-462-4877
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 WASHINGTON AVE 2ND FLOOR UNIT G
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City | PHILADELPHIA
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State | PA
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Zip | 19147
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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 |
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Name |
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Credential |
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Telephone |
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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 | DI02355900
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS038681
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License Number State | PA
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