Provider Demographics
NPI:1003847955
Name:LE, KHA DANG JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:KHA
Middle Name:DANG
Last Name:LE
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:PATRICK
Other - Middle Name:
Other - Last Name:LE
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:9900 MCFADDEN AVE
Mailing Address - Street 2:#101
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-6978
Mailing Address - Country:US
Mailing Address - Phone:714-531-5770
Mailing Address - Fax:714-531-1427
Practice Address - Street 1:9900 MCFADDEN AVE
Practice Address - Street 2:#101
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-6978
Practice Address - Country:US
Practice Address - Phone:714-531-5770
Practice Address - Fax:714-531-1427
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41453122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9262101OtherDENTI CAL