Provider Demographics
NPI:1902923816
Name:SIE, CHRISTINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:
Last Name:SIE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ENDANG
Other - Middle Name:
Other - Last Name:KOSASIH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2140 GRAND AVE
Mailing Address - Street 2:SUITE 225
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-6800
Mailing Address - Country:US
Mailing Address - Phone:909-364-8424
Mailing Address - Fax:909-364-8417
Practice Address - Street 1:2140 GRAND AVE
Practice Address - Street 2:SUITE 225
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-6800
Practice Address - Country:US
Practice Address - Phone:909-364-8424
Practice Address - Fax:909-364-8417
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA428371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice