Provider Demographics
NPI:1366566481
Name:LILIANI I. LIEM, DDS, INC
Entity type:Organization
Organization Name:LILIANI I. LIEM, DDS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST - OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LILIANI
Authorized Official - Middle Name:INGE
Authorized Official - Last Name:LIEM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-362-3668
Mailing Address - Street 1:27131 ALISO CREEK RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-3363
Mailing Address - Country:US
Mailing Address - Phone:949-362-3668
Mailing Address - Fax:949-362-4683
Practice Address - Street 1:27131 ALISO CREEK RD
Practice Address - Street 2:SUITE 120
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-3363
Practice Address - Country:US
Practice Address - Phone:949-362-3668
Practice Address - Fax:949-362-4683
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LILIANI I. LIEM, DDS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-16
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA348501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty