Provider Demographics
NPI:1649391392
Name:KHA D. LE & MEN T. H. LE, DENTAL CORP.
Entity Type:Organization
Organization Name:KHA D. LE & MEN T. H. LE, DENTAL CORP.
Other - Org Name:RIVERSIDE DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:
Authorized Official - First Name:KHA
Authorized Official - Middle Name:D
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:951-781-3021
Mailing Address - Street 1:1857 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-5345
Mailing Address - Country:US
Mailing Address - Phone:951-781-3021
Mailing Address - Fax:
Practice Address - Street 1:1857 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-5345
Practice Address - Country:US
Practice Address - Phone:951-781-3021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA423511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty