Provider Demographics
NPI:1922110220
Name:CHEN, GRACE FUANG-LING (DDS MSD)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:FUANG-LING
Last Name:CHEN
Suffix:
Gender:F
Credentials:DDS MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1895 MOWRY AVE
Mailing Address - Street 2:#122
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538
Mailing Address - Country:US
Mailing Address - Phone:510-791-6807
Mailing Address - Fax:510-791-6822
Practice Address - Street 1:1895 MOWRY AVE
Practice Address - Street 2:#122
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538
Practice Address - Country:US
Practice Address - Phone:510-791-6807
Practice Address - Fax:510-791-6822
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44154122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist