Provider Demographics
NPI:1104969344
Name:CHAN, JENNIFER WU (DDS)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:WU
Last Name:CHAN
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 1:121 INVERNESS RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-3528
Mailing Address - Country:US
Mailing Address - Phone:914-965-3864
Mailing Address - Fax:
Practice Address - Street 1:169 PARK AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10703-2907
Practice Address - Country:US
Practice Address - Phone:914-965-3864
Practice Address - Fax:914-965-7577
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0500071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice