Provider Demographics
NPI:1245443191
Name:ELLAINE S. CHEN, D.D.S., INC
Entity type:Organization
Organization Name:ELLAINE S. CHEN, D.D.S., INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLAINE
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-965-6688
Mailing Address - Street 1:3845 SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91792-2763
Mailing Address - Country:US
Mailing Address - Phone:626-388-4457
Mailing Address - Fax:626-965-6680
Practice Address - Street 1:17980 CASTLETON ST
Practice Address - Street 2:SUITE #2
Practice Address - City:CITY OF INDUSTRY
Practice Address - State:CA
Practice Address - Zip Code:91748-1841
Practice Address - Country:US
Practice Address - Phone:626-965-6688
Practice Address - Fax:626-965-6680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA483671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty