Provider Demographics
NPI:1255577086
Name:KHA DANG LE AND ANNE HANGMAN LE DMD INC
Entity type:Organization
Organization Name:KHA DANG LE AND ANNE HANGMAN LE DMD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KHA
Authorized Official - Middle Name:DANG
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:909-882-7974
Mailing Address - Street 1:2150 N WATERMAN AVE
Mailing Address - Street 2:SUITE # 103
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404
Mailing Address - Country:US
Mailing Address - Phone:909-882-7974
Mailing Address - Fax:909-713-0160
Practice Address - Street 1:2150 N WATERMAN AVE
Practice Address - Street 2:SUITE # 103
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404
Practice Address - Country:US
Practice Address - Phone:909-882-7974
Practice Address - Fax:909-713-0160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA414531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty