Active NPI
Cliff Chen
- Periodontics
- Centreville, VA
National Provider Identifier
1508293937
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 0401414161
- Practice address
- 13880 Braddock Rd
Ste 109
Centreville, VA 20121-2459 - Phone
- (703) 830-9990
- NPI assigned
- Sep 30, 2013
- 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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 0401414161 | VA | Primary |
Addresses
Primary practice location
13880 Braddock Rd
Ste 109
Centreville, VA 20121-2459
Mailing address
13880 Braddock Rd
109
Centreville, VA 20121-2459
Phone (703) 830-9990
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0401414161 | VA | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1380499200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1380499200000",
"number": "1508293937",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13880 BRADDOCK RD",
"address_2": "109",
"city": "CENTREVILLE",
"state": "VA",
"postal_code": "201212459",
"telephone_number": "703-830-9990"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13880 BRADDOCK RD",
"address_2": "STE 109",
"city": "CENTREVILLE",
"state": "VA",
"postal_code": "201212459",
"telephone_number": "703-830-9990"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHEN",
"first_name": "CLIFF",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-09-30",
"last_updated": "2013-09-30",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "VA",
"license": "0401414161",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Centreville, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.