Provider Demographics
NPI:1598078966
Name:LE, LYAN (RDHAP)
Entity Type:Individual
Prefix:
First Name:LYAN
Middle Name:
Last Name:LE
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3171 JULIAN AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-4436
Mailing Address - Country:US
Mailing Address - Phone:714-499-4809
Mailing Address - Fax:
Practice Address - Street 1:3171 JULIAN AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-4436
Practice Address - Country:US
Practice Address - Phone:714-499-4809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA298124Q00000X
CA22477124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist