Provider Demographics
NPI:1417203027
Name:CHEN, JUSTINE (DDS)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2360 MCKEE RD
Mailing Address - Street 2:SUITE #2
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116
Mailing Address - Country:US
Mailing Address - Phone:408-729-8888
Mailing Address - Fax:
Practice Address - Street 1:2360 MCKEE RD
Practice Address - Street 2:SUITE #2
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116
Practice Address - Country:US
Practice Address - Phone:408-729-8888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-01
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61543122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist