Provider Demographics
NPI:1780372797
Name:EINSTEIN, LILY CHANG (DMD)
Entity type:Individual
Prefix:
First Name:LILY
Middle Name:CHANG
Last Name:EINSTEIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 S GARNET ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-4644
Mailing Address - Country:US
Mailing Address - Phone:310-846-7606
Mailing Address - Fax:
Practice Address - Street 1:2811 WILSHIRE BLVD STE 590
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4806
Practice Address - Country:US
Practice Address - Phone:310-304-1854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-27
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS044174122300000X
390200000X
CA111051122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program