Provider Demographics
NPI:1174660609
Name:VINH MY LE, DDS
Entity Type:Organization
Organization Name:VINH MY LE, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:VINH
Authorized Official - Middle Name:MY
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-280-8844
Mailing Address - Street 1:9672 GLENBROOK ST
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-3713
Mailing Address - Country:US
Mailing Address - Phone:714-484-8197
Mailing Address - Fax:
Practice Address - Street 1:9202 VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-1900
Practice Address - Country:US
Practice Address - Phone:626-280-8844
Practice Address - Fax:626-280-8848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA464021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB46402-01OtherDELTA-HFP
CAG94130-01OtherDENTI-CAL