Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0004X | Dentist Anesthesiologist | DA031825 | PA |
NPI | 1265882880 |
---|---|
Provider Name | Gina Chen |
First Address | Dallas, PA 18612-8900 |
Second Address | Old Tappan, NJ 07675-7052 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2016 |
Last Update Date | 13/02/2020 |