Provider Demographics
NPI:1275911216
Name:KHA D LE DENTAL CORP
Entity Type:Organization
Organization Name:KHA D LE DENTAL CORP
Other - Org Name:KHA DANG LE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KHA
Authorized Official - Middle Name:DANG
Authorized Official - Last Name:LE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:714-531-5770
Mailing Address - Street 1:9900 MCFADDEN AVE #101
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683
Mailing Address - Country:US
Mailing Address - Phone:714-531-5770
Mailing Address - Fax:714-531-1427
Practice Address - Street 1:9900 MCFADDEN AVE #101
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683
Practice Address - Country:US
Practice Address - Phone:714-531-5770
Practice Address - Fax:714-531-1427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-11
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41453122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty