Provider Demographics
NPI:1174184493
Name:CHAI, JENNIFER ZHANG (DMD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ZHANG
Last Name:CHAI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 WILLOW BUD DR
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91789-3865
Mailing Address - Country:US
Mailing Address - Phone:909-569-7506
Mailing Address - Fax:
Practice Address - Street 1:22 MAIN ST
Practice Address - Street 2:
Practice Address - City:STURBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01566-1246
Practice Address - Country:US
Practice Address - Phone:508-347-7171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18583891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice