Provider Demographics
NPI:1336273630
Name:CHEN, JUNG-WEI (DDS, MS, PHD)
Entity Type:Individual
Prefix:DR
First Name:JUNG-WEI
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:DDS, MS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11092 ANDERSON ST
Mailing Address - Street 2:PRINCE HALL 3301
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92350-1706
Mailing Address - Country:US
Mailing Address - Phone:909-558-4690
Mailing Address - Fax:909-558-0322
Practice Address - Street 1:11092 ANDERSON ST
Practice Address - Street 2:PRINCE HALL 3301
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92350-1706
Practice Address - Country:US
Practice Address - Phone:909-558-4690
Practice Address - Fax:909-558-0322
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208101223P0221X
CA575781223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1639270846Medicaid
TX1497075-01Medicaid