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JONATHAN PHEN
NPI 1093400160
Dentist in East Peoria, IL

Active since April 05, 2023
502 RIVERSIDE DR, EAST PEORIA, IL 61611(309) 606-5008 Get Directions Write a Review

NPPES record last updated: April 10, 2023. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Apr 10, 2023, Apr 5, 2023 (2 updates tracked since 2023).

About Jonathan Phen NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JONATHAN PHEN (NPI 1093400160) is an individual dentist in East Peoria, Illinois, licensed in Illinois (019034133) and active in the NPI registry since April 2023.

NPPES Registry Identity

NPI1093400160
Entity TypeIndividualMale
Primary Taxonomy122300000X
Provider Legal NameJONATHAN PHEN
Location Address502 RIVERSIDE DREast Peoria, IL 61611-2068
Mailing Address2121 45th St Apt 2322Highland, IN 46322-0006 · (954) 997-4175
Phone(309) 606-5008
Sole ProprietorYes
Enumeration DateApril 5, 2023
Last NPPES UpdateApril 10, 20232 updates tracked since enumeration
NPPES CertifiedApril 10, 2023
✔ NPI 1093400160 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentistDental Providers
Taxonomy Code122300000X
License✔ Licensed in IL · 019034133
Definition
A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.
502 RIVERSIDE DR, East Peoria, IL 61611
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Home State Health, Ambetter from Meridian and more.Insurance ›

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. SEO WOO CHOI DDS
Dentist
502 RIVERSIDE DR
EAST PEORIA, IL 61611
Tazewell County (309) 606-5008
SECURE DENTAL V
Clinic/Center (Dental)
502 RIVERSIDE DR
EAST PEORIA, IL 61611
Tazewell County (309) 606-5008
DR. KWANG-LIM LEE DDS
Dentist
502 RIVERSIDE DR
EAST PEORIA, IL 61611
Tazewell County (309) 606-5008

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jonathan Phen's NPI number?

The NPI number for Jonathan Phen is 1093400160. It was assigned to this individual provider in the NPPES registry on April 5, 2023.

Where is Jonathan Phen located?

Jonathan Phen practices at 502 Riverside Dr, East Peoria, IL 61611. The listed phone number is (309) 606-5008.

What is Jonathan Phen's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

What insurance does Jonathan Phen accept?

Health plans from Ambetter Health, Ambetter Health of Delaware, Ambetter from Buckeye Health Plan, Ambetter from Home State Health and Ambetter from Meridian and 11 other insurers list Jonathan Phen as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Jonathan Phen was last updated on April 10, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.