Provider Demographics
NPI:1346370509
Name:CHEN, HAI-SOU (DDS)
Entity Type:Individual
Prefix:DR
First Name:HAI-SOU
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W VALLEY BLVD STE 222
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-3759
Mailing Address - Country:US
Mailing Address - Phone:626-573-5637
Mailing Address - Fax:
Practice Address - Street 1:301 W VALLEY BLVD STE 222
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3759
Practice Address - Country:US
Practice Address - Phone:626-573-5637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA292301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice