Provider Demographics
NPI:1275915936
Name:CHEN, ELLEN NAI-YU (DDS)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:NAI-YU
Last Name:CHEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ELLEN
Other - Middle Name:
Other - Last Name:CHEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1578 EMERALD LANE
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765
Mailing Address - Country:US
Mailing Address - Phone:909-345-7095
Mailing Address - Fax:
Practice Address - Street 1:1578 EMERALD LANE
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765
Practice Address - Country:US
Practice Address - Phone:909-345-7095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44460122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist