Provider Demographics
NPI:1164789913
Name:CHEN, AMANDA ZHAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:ZHAN
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 1:3625 BUENA VISTA DRIVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864
Mailing Address - Country:US
Mailing Address - Phone:415-320-9774
Mailing Address - Fax:
Practice Address - Street 1:4827 LAGUNA PARK DR
Practice Address - Street 2:SUITE 5
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-5159
Practice Address - Country:US
Practice Address - Phone:916-392-1885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-18
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA490751223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics