Derek E Chen, DDS
Individual provider Active NPI General Practice Dentistry · Walnut, CA
NPI 1104248582 · NPPES record last updated Sep 3, 2014
Key facts
- NPI
- 1104248582
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 63076 (CA)
- Practice address
- 20265 Valley Blvd
Suite J
Walnut, CA 91789-2654 - Phone
- (909) 869-1120
- Fax
- (909) 869-6090
- NPI assigned
- Jan 20, 2014
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 63076 | CA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| JT Chen DDS Professional Corp | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 63076 | CA | Yes |
Addresses
Primary practice location
20265 Valley Blvd
Suite J
Walnut, CA 91789-2654
Mailing address
20265 Valley Blvd
Suite J
Walnut, CA 91789-2654
Phone (909) 869-1120
Other providers in Walnut, CA
- Trina Chang
- Mahroo Changizi
- Charmane Ponghirun, DDS. Inc.
- Craig Chase
- Cindy Chen
- Harvey H Chen
- Jenn Teh Chen
- Jianghua Chen
- Mary Chen
- Ming Tian Chen
All providers in Walnut, CA · General Practice Dentistry in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 3, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.