Provider Demographics
NPI:1033502729
Name:JAMES CHEN ORTHODONTICS PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:JAMES CHEN ORTHODONTICS PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:J.
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS, PHD
Authorized Official - Phone:650-570-4365
Mailing Address - Street 1:19 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-4308
Mailing Address - Country:US
Mailing Address - Phone:650-570-4365
Mailing Address - Fax:650-570-4127
Practice Address - Street 1:19 11TH AVE
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-4308
Practice Address - Country:US
Practice Address - Phone:650-570-4365
Practice Address - Fax:650-570-4127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA445761223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty