Provider Demographics
NPI:1205504859
Name:LE, KATHERINE DOAN (DDS)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:DOAN
Last Name:LE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:903 SAN RAMON VALLEY BLVD STE 126
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-4049
Mailing Address - Country:US
Mailing Address - Phone:925-552-0490
Mailing Address - Fax:
Practice Address - Street 1:903 SAN RAMON VALLEY BLVD STE 126
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-4049
Practice Address - Country:US
Practice Address - Phone:925-552-0490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1087681223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA202819984WAMedicaid