Provider Demographics
NPI:1710027370
Name:LE, TOAN VINH (DMD)
Entity Type:Individual
Prefix:DR
First Name:TOAN
Middle Name:VINH
Last Name:LE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15308 INGLEWOOD AVE # 110B
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-1958
Mailing Address - Country:US
Mailing Address - Phone:310-644-1694
Mailing Address - Fax:310-644-1694
Practice Address - Street 1:15308 INGLEWOOD AVE # 110B
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-1958
Practice Address - Country:US
Practice Address - Phone:310-644-1694
Practice Address - Fax:310-644-1694
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD357531223G0001X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG91179-01Medicaid