Provider Demographics
NPI:1609952084
Name:LE, YEN P (DDS)
Entity Type:Individual
Prefix:DR
First Name:YEN
Middle Name:P
Last Name:LE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11410 BELSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-5553
Mailing Address - Country:US
Mailing Address - Phone:619-459-4320
Mailing Address - Fax:
Practice Address - Street 1:9225 MIRA MESA BLVD
Practice Address - Street 2:206
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4820
Practice Address - Country:US
Practice Address - Phone:858-695-8851
Practice Address - Fax:858-831-7796
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA473831223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics