Provider Demographics
NPI:1689100950
Name:CHEN KIM PLLC
Entity Type:Organization
Organization Name:CHEN KIM PLLC
Other - Org Name:CIELO DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:LI
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-757-3357
Mailing Address - Street 1:2475 S COCKRELL HILL RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75211-8103
Mailing Address - Country:US
Mailing Address - Phone:626-757-3357
Mailing Address - Fax:
Practice Address - Street 1:2475 S COCKRELL HILL RD
Practice Address - Street 2:SUITE 400
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211-8103
Practice Address - Country:US
Practice Address - Phone:626-757-3357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-05
Last Update Date:2017-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29900122300000X
TX30419122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty