Provider Demographics
NPI:1083823330
Name:CHEN, CARL K (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:K
Last Name:CHEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:CARL
Other - Middle Name:KEJIN
Other - Last Name:CHEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1243 S EUCLID ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92802-1903
Mailing Address - Country:US
Mailing Address - Phone:714-772-7060
Mailing Address - Fax:714-772-7081
Practice Address - Street 1:1243 S EUCLID ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92802-1903
Practice Address - Country:US
Practice Address - Phone:714-772-7060
Practice Address - Fax:714-772-7081
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA295671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice