Healthcare Provider Details

I. General information

NPI: 1447217716
Provider Name (Legal Business Name): LI CHUN CHE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 11/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29655 THE OLD RD
CASTAIC CA
91384-4570
US

IV. Provider business mailing address

29015 VIA PATINA
VALENCIA CA
91354-3051
US

V. Phone/Fax

Practice location:
  • Phone: 661-702-8338
  • Fax:
Mailing address:
  • Phone: 317-332-9122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS101462
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: