MEDICARE: JEFFREY CHEN D.D.S., 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	44461	CA

General Provider Information

NPI Number	:	1306074489
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFREY CHEN D.D.S., INC

Provider Business Mailing Address
First Line	:	9607 LAS TUNAS DR
Second Line	:
City	:	TEMPLE CITY
State	:	CA
Zip	:	91780-2109
Country	:	US
Telephone Number	:	626-287-8488
Fax Number	:	626-287-8489

Provider Business Practice Location Address
First Line	:	9607 LAS TUNAS DR
Second Line	:
City	:	TEMPLE CITY
State	:	CA
Zip	:	91780-2109
Country	:	US
Telephone Number	:	626-287-8488
Fax Number	:	626-287-8489

Authorized Official
Title or Position	:	CEO
Name	:	DR. JEFFREY CHEN
Credential	:	D.D.S.
Telephone Number	:	626-287-8488

Provider Enumeration Date	:	06/26/2009
Last Update Date	:	06/26/2009

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