Provider Demographics
NPI:1992718225
Name:CHEN, TING-FONG (DENTIST)
Entity type:Individual
Prefix:DR
First Name:TING-FONG
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:DENTIST
Other - Prefix:
Other - First Name:TING-FONG
Other - Middle Name:
Other - Last Name:CHEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:335 W BROADWAY ST
Mailing Address - Street 2:STE A
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204
Mailing Address - Country:US
Mailing Address - Phone:818-502-1991
Mailing Address - Fax:818-502-2010
Practice Address - Street 1:335 W BROADWAY ST
Practice Address - Street 2:STE A TF CHEN DDS
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204
Practice Address - Country:US
Practice Address - Phone:818-502-1991
Practice Address - Fax:818-502-2010
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30149122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist