MEDICARE: JEREMY CHEN

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	122300000X	Dentist	102992	CA

General Provider Information

NPI Number	:	1285174722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMY CHEN

Provider Business Mailing Address
First Line	:	1107 E LAS TUNAS DR
Second Line	:
City	:	SAN GABRIEL
State	:	CA
Zip	:	91776-1701
Country	:	US
Telephone Number	:	626-285-0031
Fax Number	:

Provider Business Practice Location Address
First Line	:	1107 E LAS TUNAS DR
Second Line	:
City	:	SAN GABRIEL
State	:	CA
Zip	:	91776-1701
Country	:	US
Telephone Number	:	626-185-0031
Fax Number	:

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

Provider Enumeration Date	:	03/02/2017
Last Update Date	:	06/30/2023

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Directions to “ JEREMY CHEN ” Practice Location

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