Provider Demographics
NPI:1194883694
Name:CHEN, JACK HANCHIEH (DDS)
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:HANCHIEH
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 1:914 E GARVEY AVE
Mailing Address - Street 2:
Mailing Address - City:MONTERERY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91755
Mailing Address - Country:US
Mailing Address - Phone:626-280-5280
Mailing Address - Fax:626-280-9740
Practice Address - Street 1:914 E GARVEY AVE
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91755
Practice Address - Country:US
Practice Address - Phone:626-280-5280
Practice Address - Fax:626-280-9740
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43916122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist