Active NPI
George D. Chen, DDS
- General Practice Dentistry
- Eagle, ID
National Provider Identifier
1154449163
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 39384
- Practice address
- 1564 E Crowne Point Dr
Eagle, ID 83616 - Phone
- (916) 508-2435
- Fax
- (916) 983-6201
- NPI assigned
- Mar 27, 2007
- Last updated
- Jan 19, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 39384 | CA | Primary |
Addresses
Primary practice location
1564 E Crowne Point Dr
Eagle, ID 83616
Mailing address
1564 E Crowne Point Dr
Eagle, ID 83616
Phone (916) 508-2435
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39384 | Other | CA | STATE LICENSE NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174953600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1642550400000",
"number": "1154449163",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1564 E CROWNE POINT DR",
"city": "EAGLE",
"state": "ID",
"postal_code": "83616",
"telephone_number": "916-508-2435",
"fax_number": "916-983-6201"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1564 E CROWNE POINT DR",
"city": "EAGLE",
"state": "ID",
"postal_code": "83616",
"telephone_number": "916-508-2435",
"fax_number": "916-983-6201"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHEN",
"first_name": "GEORGE",
"middle_name": "D.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-27",
"last_updated": "2022-01-19",
"certification_date": "2022-01-19",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "39384",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE NUMBER",
"identifier": "39384",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Eagle, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.