Provider Demographics
NPI:1558524454
Name:CHEN, JING (DDS, PHD)
Entity Type:Individual
Prefix:DR
First Name:JING
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 WEST 168 STREET
Mailing Address - Street 2:P&S BOX 20, VC9-217
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032
Mailing Address - Country:US
Mailing Address - Phone:212-342-1639
Mailing Address - Fax:212-305-4609
Practice Address - Street 1:630 W 168TH ST
Practice Address - Street 2:P&S BOX 20, VC9-217
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3725
Practice Address - Country:US
Practice Address - Phone:212-342-1639
Practice Address - Fax:212-305-4609
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0000291223X0400X
NY057123-11223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics