Provider Demographics
NPI:1386936656
Name:JENNIFER CHEN, D.D.S., A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:JENNIFER CHEN, D.D.S., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:NIEN-HUI
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-261-1168
Mailing Address - Street 1:2500 BRIGDEN RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-3429
Mailing Address - Country:US
Mailing Address - Phone:626-261-1168
Mailing Address - Fax:
Practice Address - Street 1:8540 S. SEPULVEDA BLVD
Practice Address - Street 2:SUITE 705
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045
Practice Address - Country:US
Practice Address - Phone:310-645-5705
Practice Address - Fax:310-645-0407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49857122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty