MEDICARE: DR. JEFFREY C CHEN D.D.S.

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G91827-01	OTHER	CA	DENTICAL

General Provider Information

NPI Number	:	1861616500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY C CHEN D.D.S.

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	06/01/2009

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