Provider Demographics
NPI:1649516501
Name:GEORGE K. CHEW, A PROFESSIONAL DENTAL CORPORATION
Entity type:Organization
Organization Name:GEORGE K. CHEW, A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:K
Authorized Official - Last Name:CHEW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-282-9108
Mailing Address - Street 1:1009 S GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-4710
Mailing Address - Country:US
Mailing Address - Phone:626-282-9108
Mailing Address - Fax:626-282-4297
Practice Address - Street 1:1009 S GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-4710
Practice Address - Country:US
Practice Address - Phone:626-282-9108
Practice Address - Fax:626-282-4297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-21
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35825261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1174683171OtherNPI