Provider Demographics
NPI:1649725037
Name:CHEN, QUINN KUN (DDS)
Entity type:Individual
Prefix:DR
First Name:QUINN
Middle Name:KUN
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 1:120 N PEARL ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:IL
Mailing Address - Zip Code:62881-1530
Mailing Address - Country:US
Mailing Address - Phone:618-548-2020
Mailing Address - Fax:618-548-0828
Practice Address - Street 1:120 N PEARL ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IL
Practice Address - Zip Code:62881-1530
Practice Address - Country:US
Practice Address - Phone:618-548-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-16
Last Update Date:2019-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-09334122300000X
IL019031052122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0076372Medicaid