MEDICARE: DR. KUEI-CHU CHRISTIE CHEN D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	22DI02542500	NJ
2	1223G0001X	General Practice Dentistry	0569311	NY

General Provider Information

NPI Number	:	1245668458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KUEI-CHU CHRISTIE CHEN D.D.S.

Provider Business Mailing Address
First Line	:	2190 47TH ST
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11105-1308
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13630 SANFORD AVE STE LB
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11355-3137
Country	:	US
Telephone Number	:	917-519-3886
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2013
Last Update Date	:	02/13/2014

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