Provider Demographics
NPI:1376291997
Name:LE, MY HOA THI (DDS)
Entity Type:Individual
Prefix:
First Name:MY HOA
Middle Name:THI
Last Name:LE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MY HOA
Other - Middle Name:THI
Other - Last Name:LE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2263 WOODRANCH RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95131-2600
Mailing Address - Country:US
Mailing Address - Phone:408-480-3844
Mailing Address - Fax:
Practice Address - Street 1:1110 S KING RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-2118
Practice Address - Country:US
Practice Address - Phone:408-216-2095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS107188122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist