Provider Demographics
NPI:1174184493
Name:CHAI, JENNIFER ZHANG (DMD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ZHANG
Last Name:CHAI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 WILLOW BUD DR
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91789-3865
Mailing Address - Country:US
Mailing Address - Phone:909-569-7506
Mailing Address - Fax:
Practice Address - Street 1:10025 19TH AVE SE STE 202
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-4275
Practice Address - Country:US
Practice Address - Phone:425-357-8747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61575850122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist