Provider Demographics
NPI:1861616500
Name:CHEN, JEFFREY C (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:C
Last Name:CHEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9607 LAS TUNAS DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91780-2109
Mailing Address - Country:US
Mailing Address - Phone:626-287-8488
Mailing Address - Fax:626-287-8489
Practice Address - Street 1:9607 LAS TUNAS DR
Practice Address - Street 2:
Practice Address - City:TEMPLE CITY
Practice Address - State:CA
Practice Address - Zip Code:91780-2109
Practice Address - Country:US
Practice Address - Phone:626-287-8488
Practice Address - Fax:626-287-8489
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA444611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG91827-01OtherDENTICAL