Provider Demographics
NPI:1447217716
Name:CHE, LI CHUN (DDS)
Entity Type:Individual
Prefix:
First Name:LI
Middle Name:CHUN
Last Name:CHE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29015 VIA PATINA
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91354-3051
Mailing Address - Country:US
Mailing Address - Phone:317-332-9122
Mailing Address - Fax:
Practice Address - Street 1:29655 THE OLD RD
Practice Address - Street 2:
Practice Address - City:CASTAIC
Practice Address - State:CA
Practice Address - Zip Code:91384-4570
Practice Address - Country:US
Practice Address - Phone:661-702-8338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1014621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200458040AMedicaid