MEDICARE: XI 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	0401415662	VA
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	9091	SC

General Provider Information

NPI Number	:	1710417738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	XI CHEN

Provider Business Mailing Address
First Line	:	315 LYNN ST APT 200
Second Line	:
City	:	DANVILLE
State	:	VA
Zip	:	24541-1478
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5422 FOREST DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29206-5412
Country	:	US
Telephone Number	:	803-753-8064
Fax Number	:

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

Provider Enumeration Date	:	06/13/2017
Last Update Date	:	04/02/2018

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Directions to “ XI CHEN ” Practice Location

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