Provider Demographics
NPI:1043039985
Name:MA, LE WEN (DDS)
Entity type:Individual
Prefix:DR
First Name:LE WEN
Middle Name:
Last Name:MA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 BOHLIG RD APT 48
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90032-4342
Mailing Address - Country:US
Mailing Address - Phone:626-500-5845
Mailing Address - Fax:
Practice Address - Street 1:12214 LAKEWOOD BLVD STE 102
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-2663
Practice Address - Country:US
Practice Address - Phone:562-670-2036
Practice Address - Fax:562-247-9788
Is Sole Proprietor?:No
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1108891223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice