Provider Demographics
NPI:1447805890
Name:KHA D LE DENTAL CORP.
Entity Type:Organization
Organization Name:KHA D LE DENTAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:KHA
Authorized Official - Middle Name:D
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:949-644-1001
Mailing Address - Street 1:2121 E COAST HWY STE 220
Mailing Address - Street 2:
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625-1934
Mailing Address - Country:US
Mailing Address - Phone:949-644-1001
Mailing Address - Fax:949-644-4445
Practice Address - Street 1:2121 E COAST HWY STE 220
Practice Address - Street 2:
Practice Address - City:CORONA DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92625-1934
Practice Address - Country:US
Practice Address - Phone:949-644-1001
Practice Address - Fax:949-644-4445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-02
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental