Provider Demographics
NPI:1467511360
Name:CHIEM, CHRISTINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:
Last Name:CHIEM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5825 LINCOLN AVE
Mailing Address - Street 2:STE H
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-3477
Mailing Address - Country:US
Mailing Address - Phone:714-761-1736
Mailing Address - Fax:
Practice Address - Street 1:5971 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-3580
Practice Address - Country:US
Practice Address - Phone:714-995-3976
Practice Address - Fax:714-995-7124
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49290122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist