MEDICARE: DR. WENDY CHIEM D.D.S

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	47356	CA
2	1223G0001X	General Practice Dentistry	4890	NV

General Provider Information

NPI Number	:	1902965809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WENDY CHIEM D.D.S

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	:

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	:	702-395-3047

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	06/24/2013

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