MEDICARE: ANDREW C. CHEN, DDS, INC.

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

General Provider Information

NPI Number	:	1306004973
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDREW C. CHEN, DDS, INC.

Provider Business Mailing Address
First Line	:	3015 TRAP ROCK WAY
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95835-1858
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3015 TRAP ROCK WAY
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95835-1858
Country	:	US
Telephone Number	:	916-837-9694
Fax Number	:

Authorized Official
Title or Position	:	CEO, SECRETARY, CFO
Name	:	ANDREW CHEN
Credential	:
Telephone Number	:	916-837-9694

Provider Enumeration Date	:	05/29/2008
Last Update Date	:	05/29/2008

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