Provider Demographics
NPI:1558778316
Name:LE, ABRAHAM SI-VIET (DDS)
Entity Type:Individual
Prefix:DR
First Name:ABRAHAM
Middle Name:SI-VIET
Last Name:LE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:ABE
Other - Middle Name:SI-VIET
Other - Last Name:LE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:6145 NE RADFORD DR APT 924
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-7976
Mailing Address - Country:US
Mailing Address - Phone:425-246-0829
Mailing Address - Fax:
Practice Address - Street 1:1418 164TH ST SW
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98087-8500
Practice Address - Country:US
Practice Address - Phone:425-742-8828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-14
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 60485731122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist