Provider Demographics
NPI:1073165981
Name:HSIEH, WILLIS WEI (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIS
Middle Name:WEI
Last Name:HSIEH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 S HACIENDA BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-4265
Mailing Address - Country:US
Mailing Address - Phone:626-336-2588
Mailing Address - Fax:626-336-3337
Practice Address - Street 1:2020 S HACIENDA BLVD STE A
Practice Address - Street 2:
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-4265
Practice Address - Country:US
Practice Address - Phone:626-336-2588
Practice Address - Fax:626-336-3337
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1039751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice