Provider Demographics
NPI:1730480062
Name:LE, NIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:NIA
Middle Name:
Last Name:LE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3821 MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-2140
Mailing Address - Country:US
Mailing Address - Phone:949-262-0151
Mailing Address - Fax:
Practice Address - Street 1:6543 TOPANGA CANYON BLVD
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91303-2622
Practice Address - Country:US
Practice Address - Phone:877-227-9892
Practice Address - Fax:800-967-2147
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA590581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice