Provider Demographics
NPI:1346366390
Name:CHAU, LE B (DDS)
Entity Type:Individual
Prefix:
First Name:LE
Middle Name:B
Last Name:CHAU
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 1:750 N CAPITOL AVE
Mailing Address - Street 2:SUITE C-6
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95133-1913
Mailing Address - Country:US
Mailing Address - Phone:408-923-0500
Mailing Address - Fax:408-923-0590
Practice Address - Street 1:750 N CAPITOL AVE
Practice Address - Street 2:SUITE C-6
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95133-1913
Practice Address - Country:US
Practice Address - Phone:408-923-0500
Practice Address - Fax:408-923-0590
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA417131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB41713-01Medicaid