Provider Demographics
NPI:1396439428
Name:JIMENEZ, CHRISTOPHER BRYAN
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:BRYAN
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4245 NOVEL CT
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-6185
Mailing Address - Country:US
Mailing Address - Phone:323-203-4038
Mailing Address - Fax:
Practice Address - Street 1:4245 NOVEL CT
Practice Address - Street 2:
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-6185
Practice Address - Country:US
Practice Address - Phone:323-203-4038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-02
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111518122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist