Provider Demographics
NPI:1487860250
Name:LE, KHAM TD (DDS)
Entity Type:Individual
Prefix:
First Name:KHAM
Middle Name:TD
Last Name:LE
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 1:3736 S BRISTOL ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-7304
Mailing Address - Country:US
Mailing Address - Phone:714-751-5538
Mailing Address - Fax:714-751-0431
Practice Address - Street 1:3736 S BRISTOL ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-7304
Practice Address - Country:US
Practice Address - Phone:714-751-5538
Practice Address - Fax:714-751-0431
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA436301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice