Provider Demographics
NPI:1598891988
Name:LE, KHOA DAI (DDS)
Entity Type:Individual
Prefix:
First Name:KHOA
Middle Name:DAI
Last Name:LE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8181 BOLSA AVE
Mailing Address - Street 2:
Mailing Address - City:MIDWAY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92655-1223
Mailing Address - Country:US
Mailing Address - Phone:714-698-8181
Mailing Address - Fax:714-698-1609
Practice Address - Street 1:8181 BOLSA AVE
Practice Address - Street 2:
Practice Address - City:MIDWAY CITY
Practice Address - State:CA
Practice Address - Zip Code:92655-1223
Practice Address - Country:US
Practice Address - Phone:714-698-8181
Practice Address - Fax:714-698-1609
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31942122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist