Provider Demographics
NPI:1295393445
Name:KEVIN THAI LE DDS, INC
Entity Type:Organization
Organization Name:KEVIN THAI LE DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:THAI
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-757-8953
Mailing Address - Street 1:18845 SHERMAN WAY STE J
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-4042
Mailing Address - Country:US
Mailing Address - Phone:818-757-8953
Mailing Address - Fax:
Practice Address - Street 1:18845 SHERMAN WAY STE J
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4042
Practice Address - Country:US
Practice Address - Phone:818-757-8953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-03
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental