Provider Demographics
NPI:1215931209
Name:CHEN, CHIEN CHUAN (DMD)
Entity type:Individual
Prefix:DR
First Name:CHIEN CHUAN
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:PETER CHIEN CHUAN
Other - Middle Name:
Other - Last Name:CHEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:19155 COLIMA RD
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-3003
Mailing Address - Country:US
Mailing Address - Phone:626-854-0091
Mailing Address - Fax:626-854-0991
Practice Address - Street 1:19155 COLIMA RD
Practice Address - Street 2:
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-3003
Practice Address - Country:US
Practice Address - Phone:626-854-0091
Practice Address - Fax:626-854-0991
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA389751223G0001X
MA178311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice