Provider Demographics
NPI:1922232511
Name:CHEN, JENNIFER MING-I (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MING-I
Last Name:CHEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3655 THORNHILL DR
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94551-0114
Mailing Address - Country:US
Mailing Address - Phone:925-961-1628
Mailing Address - Fax:925-961-1628
Practice Address - Street 1:22273 MAIN ST
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-4004
Practice Address - Country:US
Practice Address - Phone:510-581-1772
Practice Address - Fax:510-581-1775
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-11
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA551371223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist