Provider Demographics
NPI:1629219456
Name:SHEU, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:SHEU
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:SHEU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2660 WAGON TRAIN LN
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-3646
Mailing Address - Country:US
Mailing Address - Phone:909-964-1277
Mailing Address - Fax:
Practice Address - Street 1:2660 WAGON TRAIN LN
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-3646
Practice Address - Country:US
Practice Address - Phone:909-964-1277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-06
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA580461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice