Provider Demographics
NPI:1518235282
Name:JESSICA HY CHEN DDS PS
Entity Type:Organization
Organization Name:JESSICA HY CHEN DDS PS
Other - Org Name:DUVALL FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HONG
Authorized Official - Middle Name:Y
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-312-3889
Mailing Address - Street 1:14142 MAIN ST NE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DUVALL
Mailing Address - State:WA
Mailing Address - Zip Code:98019-9007
Mailing Address - Country:US
Mailing Address - Phone:425-224-6890
Mailing Address - Fax:
Practice Address - Street 1:14142 MAIN ST NE
Practice Address - Street 2:SUITE 104
Practice Address - City:DUVALL
Practice Address - State:WA
Practice Address - Zip Code:98019-9007
Practice Address - Country:US
Practice Address - Phone:425-224-6890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE600738731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty