Provider Demographics
NPI:1639255961
Name:CHEN, GINNIE I (DDS)
Entity Type:Individual
Prefix:
First Name:GINNIE
Middle Name:I
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 1:13420 NEWPORT AVE
Mailing Address - Street 2:#L
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780
Mailing Address - Country:US
Mailing Address - Phone:714-544-1391
Mailing Address - Fax:714-544-5090
Practice Address - Street 1:13420 NEWPORT AVE
Practice Address - Street 2:#L
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780
Practice Address - Country:US
Practice Address - Phone:714-544-1391
Practice Address - Fax:714-544-5090
Is Sole Proprietor?:No
Enumeration Date:2006-10-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA472411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice