Provider Demographics
NPI:1639392921
Name:CATHERINE LE, DDS, INC.
Entity Type:Organization
Organization Name:CATHERINE LE, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.D.S
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-268-8188
Mailing Address - Street 1:2171 ULRIC ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-6690
Mailing Address - Country:US
Mailing Address - Phone:858-268-8188
Mailing Address - Fax:858-268-2864
Practice Address - Street 1:2171 ULRIC ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-6690
Practice Address - Country:US
Practice Address - Phone:858-268-8188
Practice Address - Fax:858-268-2864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA418471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1083754725Medicaid
CA820211OtherUNITED CONCORDIA
CA=========OtherCDN