Provider Demographics
NPI:1164507877
Name:LE, THUY BICH (DDS)
Entity Type:Individual
Prefix:DR
First Name:THUY
Middle Name:BICH
Last Name:LE
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 1:391 S STATE COLLEGE BLVD STE M
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-5755
Mailing Address - Country:US
Mailing Address - Phone:714-990-3321
Mailing Address - Fax:
Practice Address - Street 1:391 S STATE COLLEGE BLVD STE M
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-5755
Practice Address - Country:US
Practice Address - Phone:714-990-3321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA493571223G0001X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223G0001XDental ProvidersDentistGeneral Practice