Provider Demographics
NPI:1942667217
Name:LI&WEN DENTAL CORPORATION
Entity Type:Organization
Organization Name:LI&WEN DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:IVY
Authorized Official - Middle Name:XINWEI
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-445-2178
Mailing Address - Street 1:945 W DUARTE RD
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-4306
Mailing Address - Country:US
Mailing Address - Phone:626-445-2178
Mailing Address - Fax:626-425-9518
Practice Address - Street 1:945 W DUARTE RD
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-4306
Practice Address - Country:US
Practice Address - Phone:626-445-2178
Practice Address - Fax:626-425-9518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-18
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47934122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty