Provider Demographics
NPI:1356489975
Name:FANG-LALAS, ADRIENNE LEI-GWUN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ADRIENNE
Middle Name:LEI-GWUN
Last Name:FANG-LALAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ADRIENNE
Other - Middle Name:LEI-GWUN
Other - Last Name:FANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1037 N VISTA ST
Mailing Address - Street 2:APT. #201
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-6642
Mailing Address - Country:US
Mailing Address - Phone:818-795-1391
Mailing Address - Fax:
Practice Address - Street 1:27420 TOURNEY RD
Practice Address - Street 2:STE. #280
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-5601
Practice Address - Country:US
Practice Address - Phone:661-253-0588
Practice Address - Fax:661-253-0486
Is Sole Proprietor?:No
Enumeration Date:2007-02-03
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA523861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice