Provider Demographics
NPI:1033322680
Name:CHI, CHIA CHEN SUSAN (DMD)
Entity type:Individual
Prefix:DR
First Name:CHIA CHEN
Middle Name:SUSAN
Last Name:CHI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11200 BROADWAY ST STE 2703
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-0140
Mailing Address - Country:US
Mailing Address - Phone:281-719-9369
Mailing Address - Fax:
Practice Address - Street 1:11200 BROADWAY ST STE 2703
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-0140
Practice Address - Country:US
Practice Address - Phone:281-719-9369
Practice Address - Fax:281-719-9369
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21563122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist