Provider Demographics
NPI:1104851062
Name:CHEN, CHRISTY Y (DDS)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTY
Middle Name:Y
Last Name:CHEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4653 CARMEL MOUNTAIN ROAD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130
Mailing Address - Country:US
Mailing Address - Phone:858-350-0045
Mailing Address - Fax:858-228-4367
Practice Address - Street 1:205 W MISSION AVE
Practice Address - Street 2:SUITE V
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-1733
Practice Address - Country:US
Practice Address - Phone:760-489-2600
Practice Address - Fax:760-301-8007
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA439141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice