Provider Demographics
NPI:1841336898
Name:CHEN, PETER
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2144 S BRISTOL ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-5123
Mailing Address - Country:US
Mailing Address - Phone:714-784-5779
Mailing Address - Fax:323-249-7565
Practice Address - Street 1:2144 S BRISTOL ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-5123
Practice Address - Country:US
Practice Address - Phone:714-784-5779
Practice Address - Fax:323-249-7565
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA474601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD47460Medicaid