Basic Information
| Provider Information | |||||||||
| NPI: | 1841617586 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHEN | ||||||||
| FirstName: | KENG YU | ||||||||
| MiddleName: | |||||||||
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| Credential: | D.M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1060 GAFFNEY RD | ||||||||
| Address2: | #7500 | ||||||||
| City: | FORT WAINWRIGHT | ||||||||
| State: | AK | ||||||||
| PostalCode: | 997035001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073535530 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1060 GAFFNEY RD | ||||||||
| Address2: | #7500 | ||||||||
| City: | FORT WAINWRIGHT | ||||||||
| State: | AK | ||||||||
| PostalCode: | 997035001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073535530 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2014 | ||||||||
| LastUpdateDate: | 03/19/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 29507 | TX | Y | Dental Providers | Dentist |
No ID Information.