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General NPI Number Information
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NPI Number | 1043039985
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Entity Type | Individual
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Provider Name | LE WEN MA DDS
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Gender | Female
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Dates
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Enumeration Date | 10/08/2024
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Last Update Date | 10/08/2024
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Provider Practice Location Address
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Address Line | 12214 LAKEWOOD BLVD STE 102
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City | DOWNEY
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State | CA
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Zip | 90242-2663
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Country | US
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Telephone | 562-670-2036
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Fax | 562-247-9788
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Provider Business Mailing Address
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Address Line | 5501 BOHLIG RD APT 48
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City | LOS ANGELES
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State | CA
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Zip | 90032-4342
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Country | US
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Telephone | 626-500-5845
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 110889
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 110889
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License Number State | CA
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