Provider Demographics
NPI:1649587965
Name:AU, LE TIEN DUONG (DDS)
Entity Type:Individual
Prefix:DR
First Name:LE TIEN
Middle Name:DUONG
Last Name:AU
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 1:23634 PALOMINO DR
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-1627
Mailing Address - Country:US
Mailing Address - Phone:714-548-0113
Mailing Address - Fax:
Practice Address - Street 1:1630 E 4TH ST
Practice Address - Street 2:#M
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-2604
Practice Address - Country:US
Practice Address - Phone:909-984-7872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA589591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice