Provider Demographics
NPI:1336411339
Name:CHEN, ANDREW LI (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:LI
Last Name:CHEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 E EMERSON AVE APT B
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91755-1743
Mailing Address - Country:US
Mailing Address - Phone:626-757-3357
Mailing Address - Fax:
Practice Address - Street 1:125 E EMERSON AVE APT B
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91755-1743
Practice Address - Country:US
Practice Address - Phone:626-757-3357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA610691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice