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NPI Code Detail

MEDICARE: DERRICK CHEN

MEDICARE: DERRICK 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
1122300000XDentistDN15573GA

General Provider Information

NPI Number : 1396081014
Entity Type Code : Individual
Provider Name (Legal Business Name) : DERRICK CHEN
Provider Business Mailing Address
First Line : 3560 PEACHTREE INDUSTRIAL BLVD
Second Line :
City : DULUTH
State : GA
Zip : 30096-4817
Country : US
Telephone Number : 678-584-9266
Fax Number : 678-584-1424
Provider Business Practice Location Address
First Line : 3560 PEACHTREE INDUSTRIAL BLVD
Second Line :
City : DULUTH
State : GA
Zip : 30096-4817
Country : US
Telephone Number : 678-584-9266
Fax Number : 678-584-1424
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/28/2012
Last Update Date : 09/08/2025

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Directions to “ DERRICK CHEN ” Practice Location

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