Provider Demographics
NPI:1356458020
Name:CHEN, ELLEN L (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:L
Last Name:CHEN
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 1:20147 S PIONEER BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90715
Mailing Address - Country:US
Mailing Address - Phone:562-924-0558
Mailing Address - Fax:562-924-2059
Practice Address - Street 1:20147 S PIONEER BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90715
Practice Address - Country:US
Practice Address - Phone:562-924-0558
Practice Address - Fax:562-924-2059
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22140122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist