Provider Demographics
NPI:1821425497
Name:KHOI LE, D.D.S INC.
Entity Type:Organization
Organization Name:KHOI LE, D.D.S INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KHOI
Authorized Official - Middle Name:DINH
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:831-637-9122
Mailing Address - Street 1:889 SUNSET DR
Mailing Address - Street 2:A
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-5601
Mailing Address - Country:US
Mailing Address - Phone:831-637-9122
Mailing Address - Fax:831-637-2612
Practice Address - Street 1:889 SUNSET DR
Practice Address - Street 2:A
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-5601
Practice Address - Country:US
Practice Address - Phone:831-637-9122
Practice Address - Fax:831-637-2612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58147122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty