Provider Demographics
NPI:1750862660
Name:CHEN, STEPHANIE (DMD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 W WOODRUFF AVE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-8344
Mailing Address - Country:US
Mailing Address - Phone:626-757-3269
Mailing Address - Fax:
Practice Address - Street 1:1120 S SAN GABRIEL BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3160
Practice Address - Country:US
Practice Address - Phone:626-757-3269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1029611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice