Provider Demographics
NPI:1073769022
Name:LE, KHANG TUONG (DDS)
Entity Type:Individual
Prefix:DR
First Name:KHANG
Middle Name:TUONG
Last Name:LE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3755 S PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-7463
Mailing Address - Country:US
Mailing Address - Phone:310-809-7211
Mailing Address - Fax:
Practice Address - Street 1:3755 S PLAZA DR
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-7463
Practice Address - Country:US
Practice Address - Phone:310-257-8043
Practice Address - Fax:310-257-1155
Is Sole Proprietor?:No
Enumeration Date:2008-08-11
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA440051223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics