Kenneth K Chen, D.M.D.
Individual provider Active NPI General Practice Dentistry · Palisades Park, NJ
NPI 1972684686 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1972684686
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 22DI02272500 (NJ)
- Practice address
- 131 Broad Ave
Palisades Park, NJ 07650-1441 - Phone
- (201) 947-6060
- Fax
- (201) 461-0544
- NPI assigned
- Oct 18, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150805008934 | NJ | Order and Referring Only - Other (Physician) |
1254645120 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22DI02272500 | NJ | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 22DI02272500 | NJ | Yes |
Addresses
Primary practice location
131 Broad Ave
Palisades Park, NJ 07650-1441
Mailing address
131 Broad Ave
Palisades Park, NJ 07650-1441
Phone (201) 947-6060
Other providers in Palisades Park, NJ
- Broadway Optical LLC
- Broadway Optical LLC
- Alfonso C. Bullock II
- Careone Physical Therapy, P.C.
- Chamomile Counseling LLC
- Winston W Chen
- Ki-Young Cho
- Minhyun Cho
- Naeun Cho
- Yoonju Cho
All providers in Palisades Park, NJ · General Practice Dentistry in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.