Provider Demographics
NPI:1710918263
Name:CHEN, JENNY J
Entity Type:Individual
Prefix:DR
First Name:JENNY
Middle Name:J
Last Name:CHEN
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:JI-YU
Other - Middle Name:
Other - Last Name:CHEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:450 SUTTER STREET, SUITE1438
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108
Mailing Address - Country:US
Mailing Address - Phone:415-986-9868
Mailing Address - Fax:
Practice Address - Street 1:450 SUTTER ST RM 1438
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-4010
Practice Address - Country:US
Practice Address - Phone:415-986-9868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA379871223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics