Provider Demographics
NPI:1558589176
Name:LE, NINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:NINA
Middle Name:
Last Name:LE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:13252 HAWTHORNE BLVD
Mailing Address - Street 2:STE. 204
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-5804
Mailing Address - Country:US
Mailing Address - Phone:310-973-0007
Mailing Address - Fax:310-973-5817
Practice Address - Street 1:13252 HAWTHORNE BLVD
Practice Address - Street 2:STE. 204
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-5804
Practice Address - Country:US
Practice Address - Phone:310-973-0007
Practice Address - Fax:310-973-5817
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA491311223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry