Provider Demographics
NPI:1255744314
Name:CHEN, FRED (DMD)
Entity type:Individual
Prefix:
First Name:FRED
Middle Name:
Last Name:CHEN
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98-211 PALI MOMI ST STE 615
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4337
Mailing Address - Country:US
Mailing Address - Phone:808-484-4459
Mailing Address - Fax:808-404-9759
Practice Address - Street 1:98-211 PALI MOMI ST STE 615
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4337
Practice Address - Country:US
Practice Address - Phone:808-484-4459
Practice Address - Fax:808-404-9759
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-06
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT27771223P0221X
390200000390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty