MEDICARE: WENDY CHIEM, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1275008526
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WENDY CHIEM, LLC

Provider Business Mailing Address
First Line	:	5840 W CRAIG RD STE 130
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-2573
Country	:	US
Telephone Number	:	702-395-3047
Fax Number	:	702-395-8918

Provider Business Practice Location Address
First Line	:	5840 W CRAIG RD STE 130
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-2573
Country	:	US
Telephone Number	:	702-395-3047
Fax Number	:	702-395-8918

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. WENDY UYEN CHIEM
Credential	:	DDS
Telephone Number	:	702-468-8168

Provider Enumeration Date	:	10/12/2018
Last Update Date	:	10/12/2018

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