Provider Demographics
NPI:1669677571
Name:LE, TINA THUYKHANH (DDS)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:THUYKHANH
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 1:827 ALTOS OAKS DR STE 3
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-5490
Mailing Address - Country:US
Mailing Address - Phone:650-948-6273
Mailing Address - Fax:650-948-5663
Practice Address - Street 1:827 ALTOS OAKS DR STE 3
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-5490
Practice Address - Country:US
Practice Address - Phone:650-948-6273
Practice Address - Fax:650-948-5663
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA473841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice