Provider Demographics
NPI:1992956650
Name:CHEN, MIKE M (DMD)
Entity type:Individual
Prefix:DR
First Name:MIKE
Middle Name:M
Last Name:CHEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 BLOSSOM HILL RD
Mailing Address - Street 2:STE 150
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-1652
Mailing Address - Country:US
Mailing Address - Phone:408-629-6704
Mailing Address - Fax:408-629-9976
Practice Address - Street 1:393 BLOSSOM HILL RD
Practice Address - Street 2:STE 150
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-1652
Practice Address - Country:US
Practice Address - Phone:408-629-6704
Practice Address - Fax:408-629-9976
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39615122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist