Provider Demographics
NPI:1609895184
Name:LE, DIEP H (DDS)
Entity Type:Individual
Prefix:DR
First Name:DIEP
Middle Name:H
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 1:195 MERIDIAN ST STE A5
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-2221
Mailing Address - Country:US
Mailing Address - Phone:408-298-4532
Mailing Address - Fax:831-630-5721
Practice Address - Street 1:195 MERIDIAN ST STE A5
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-2221
Practice Address - Country:US
Practice Address - Phone:408-298-4532
Practice Address - Fax:831-630-5721
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43033122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA43033OtherCA LICENSE