Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 40215 | CA |
N | 122300000X | Dentist | D40215 | CA |
Y | 1223D0004X | Dentist Anesthesiologist | G1032 | CA |
NPI | 1265648570 |
---|---|
Provider Name | Dr. Andrew H. Chen |
First Address | Newbury Park, CA 91320 |
Second Address | Newbury Park, CA 91320 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2007 |
Last Update Date | 20/05/2013 |