Provider Demographics
NPI:1700946084
Name:HSIEH, CHUNG-LING (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHUNG-LING
Middle Name:
Last Name:HSIEH
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 1:7690 LAKE ADLON DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92119-2518
Mailing Address - Country:US
Mailing Address - Phone:619-465-2008
Mailing Address - Fax:858-573-1107
Practice Address - Street 1:4620 CONVOY ST
Practice Address - Street 2:SUITE G
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-2328
Practice Address - Country:US
Practice Address - Phone:858-573-1105
Practice Address - Fax:858-573-1107
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA349731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice