Provider Demographics
NPI:1851530844
Name:CHEN, DERRICK YIN SAU (DDS)
Entity Type:Individual
Prefix:DR
First Name:DERRICK
Middle Name:YIN SAU
Last Name:CHEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:YIN SAU
Other - Middle Name:
Other - Last Name:CHEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:7603 16TH AVE
Mailing Address - Street 2:APT 1F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-1007
Mailing Address - Country:US
Mailing Address - Phone:917-238-9808
Mailing Address - Fax:
Practice Address - Street 1:7603 16TH AVE
Practice Address - Street 2:APT 1F
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-1007
Practice Address - Country:US
Practice Address - Phone:917-238-9808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-13
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY054665122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program