Organization Name: | JT CHEN DDS PROFESSIONAL CORP |
NPI Number: | 1336547959 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | J T CHEN (OWNER/PROPRIETOR) |
Mailing Address: | 20265 Valley Blvd Suite #j Walnut |
State: | CA US |
Postal Code: | 917892654 |
Phone Number: | 9098691120 |
Fax Number: | 9098696090 |
NPI Enumeration Date: | 12/12/2014 |
NPI Last Update Date: | 12/12/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | 28131 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |