Provider Demographics
NPI:1508911884
Name:JEN, DAVID CHIH-YUAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CHIH-YUAN
Last Name:JEN
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 1:1727 N RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-8062
Mailing Address - Country:US
Mailing Address - Phone:626-318-6318
Mailing Address - Fax:
Practice Address - Street 1:1727 N RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-8062
Practice Address - Country:US
Practice Address - Phone:909-961-2068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA361591223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics