Provider Demographics
NPI:1720276397
Name:HAI-SOU CHEN, DDS, A PROFESSIONAL CORP.
Entity Type:Organization
Organization Name:HAI-SOU CHEN, DDS, A PROFESSIONAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HAI-SOU
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-573-5637
Mailing Address - Street 1:301 W VALLEY BLVD STE 222
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-3759
Mailing Address - Country:US
Mailing Address - Phone:626-573-5637
Mailing Address - Fax:626-308-9659
Practice Address - Street 1:301 W VALLEY BLVD STE 222
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3759
Practice Address - Country:US
Practice Address - Phone:626-573-5637
Practice Address - Fax:626-308-9659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29230302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization