Provider Demographics
NPI:1073885505
Name:CHEN, J JAMES (DDS,, MS,, PHD)
Entity type:Individual
Prefix:DR
First Name:J
Middle Name:JAMES
Last Name:CHEN
Suffix:
Gender:M
Credentials:DDS,, MS,, PHD
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Mailing Address - Street 1:19 11TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-4308
Mailing Address - Country:US
Mailing Address - Phone:650-570-4365
Mailing Address - Fax:650-570-4127
Practice Address - Street 1:19 11TH AVENUE
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-4308
Practice Address - Country:US
Practice Address - Phone:650-570-4365
Practice Address - Fax:650-570-4127
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA445761223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics