Provider Demographics
NPI:1134247240
Name:CHEN, PENGJEN KEVIN (DMD MS)
Entity type:Individual
Prefix:
First Name:PENGJEN
Middle Name:KEVIN
Last Name:CHEN
Suffix:
Gender:M
Credentials:DMD MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 HAWKCREST CIRCLE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95835
Mailing Address - Country:US
Mailing Address - Phone:916-419-6738
Mailing Address - Fax:916-419-6738
Practice Address - Street 1:1810 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825
Practice Address - Country:US
Practice Address - Phone:916-971-3461
Practice Address - Fax:916-973-9830
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA467671223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics