MEDICARE: DR. JESSICA CHIMA DMD

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	10346	NC
2	1223G0001X	General Practice Dentistry	10346	NC

General Provider Information

NPI Number	:	1609223544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA CHIMA DMD

Provider Business Mailing Address
First Line	:	2130 CHIPLEY DR
Second Line	:
City	:	CARY
State	:	NC
Zip	:	27519-6990
Country	:	US
Telephone Number	:	309-825-0716
Fax Number	:

Provider Business Practice Location Address
First Line	:	1625 N MAIN ST STE 201
Second Line	:
City	:	FUQUAY VARINA
State	:	NC
Zip	:	27526-5399
Country	:	US
Telephone Number	:	919-557-7799
Fax Number	:

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

Provider Enumeration Date	:	05/20/2016
Last Update Date	:	12/30/2016

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