Provider Demographics
NPI:1356751549
Name:YEN P. LE, DDS, INC
Entity type:Organization
Organization Name:YEN P. LE, DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-695-8851
Mailing Address - Street 1:1511 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-2407
Mailing Address - Country:US
Mailing Address - Phone:760-891-0757
Mailing Address - Fax:760-891-0785
Practice Address - Street 1:1511 GRAND AVE
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-2407
Practice Address - Country:US
Practice Address - Phone:760-891-0757
Practice Address - Fax:760-891-0785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-28
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47383122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty