Provider Demographics
NPI:1376038661
Name:CHAE, JIMMY (DDS)
Entity Type:Individual
Prefix:DR
First Name:JIMMY
Middle Name:
Last Name:CHAE
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 1:52 KARENS LN
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-1905
Mailing Address - Country:US
Mailing Address - Phone:201-230-1759
Mailing Address - Fax:
Practice Address - Street 1:696 ANDERSON AVE # 2NDF
Practice Address - Street 2:
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010-2079
Practice Address - Country:US
Practice Address - Phone:201-945-1094
Practice Address - Fax:201-945-1124
Is Sole Proprietor?:No
Enumeration Date:2018-06-28
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0607111223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program