Provider Demographics
NPI:1992057202
Name:NOH, GRACE CHEN (DDS)
Entity type:Individual
Prefix:DR
First Name:GRACE
Middle Name:CHEN
Last Name:NOH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:GRACE
Other - Middle Name:
Other - Last Name:CHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20370 TRAILS END RD
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-1837
Mailing Address - Country:US
Mailing Address - Phone:862-754-6063
Mailing Address - Fax:
Practice Address - Street 1:20370 TRAILS END RD
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-1837
Practice Address - Country:US
Practice Address - Phone:862-754-6063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1049251223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics