1386173862 NPI number — CHRISTY LANJIE CHEN DDS

Table of content: CHRISTY LANJIE CHEN DDS (NPI 1386173862)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386173862 NPI number — CHRISTY LANJIE CHEN DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHEN
Provider First Name:
CHRISTY
Provider Middle Name:
LANJIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHEN
Provider Other First Name:
YINGJIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1386173862
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1716 HARTFORD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47904-2138
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-742-1567
Provider Business Mailing Address Fax Number:
765-429-2700

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1324 TIPPECANOE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47904-2051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-742-1567
Provider Business Practice Location Address Fax Number:
765-429-2794
Provider Enumeration Date:
06/08/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  12012749A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 300006391 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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