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General NPI Number Information
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NPI Number | 1942667217
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Entity Type | Organization
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Legal Business Name | LI&WEN DENTAL CORPORATION
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Dates
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Enumeration Date | 01/18/2016
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Last Update Date | 01/18/2016
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Provider Practice Location Address
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Address Line | 945 W DUARTE RD
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City | MONROVIA
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State | CA
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Zip | 91016-4306
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Country | US
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Telephone | 626-445-2178
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Fax | 626-425-9518
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Provider Business Mailing Address
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Address Line | 945 W DUARTE RD
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City | MONROVIA
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State | CA
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Zip | 91016-4306
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Country | US
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Telephone | 626-445-2178
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Fax | 626-425-9518
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Authorized Official
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Title or Position | DENTIST
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Name | IVY XINWEI LI
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Credential | DDS
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Telephone | 626-445-2178
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 47934
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License Number State | CA
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