Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 56523 | CA |
Y | 204E00000X | Oral & Maxillofacial Surgeon | A122340 | CA |
NPI | 1194967174 |
---|---|
Provider Name | Dr. Jennifer Perkins Chen |
First Address | San Francisco, CA 94143 |
Second Address | San Francisco, CA 94143 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2009 |
Last Update Date | 10/09/2018 |