Provider Demographics
NPI:1811623515
Name:CHEN, JEREMY CHUNG-HUAN (DDS)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:CHUNG-HUAN
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 1:6127 CORTE DE LA REINA
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-4409
Mailing Address - Country:US
Mailing Address - Phone:408-888-8645
Mailing Address - Fax:
Practice Address - Street 1:1406 LUISA ST STE 1
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4161
Practice Address - Country:US
Practice Address - Phone:505-303-4503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-26
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD56771223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice