Provider Demographics
NPI:1679783278
Name:CHEN, YEN-CHIU (DDS)
Entity type:Individual
Prefix:DR
First Name:YEN-CHIU
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 TEE LN
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-3607
Mailing Address - Country:US
Mailing Address - Phone:631-474-7270
Mailing Address - Fax:631-474-7270
Practice Address - Street 1:111 SITHTOWN BYPASS
Practice Address - Street 2:SUITE 217
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788
Practice Address - Country:US
Practice Address - Phone:631-724-0900
Practice Address - Fax:631-724-0013
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049953-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice