Provider Demographics
NPI:1457542771
Name:KHA DANG LE DMD POFESIONAL CORP
Entity Type:Organization
Organization Name:KHA DANG LE DMD POFESIONAL CORP
Other - Org Name:ORANGE ART OF DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
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:714-938-0568
Mailing Address - Street 1:146 S. MAIN ST.
Mailing Address - Street 2:STE. M
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868
Mailing Address - Country:US
Mailing Address - Phone:714-938-0568
Mailing Address - Fax:714-938-1430
Practice Address - Street 1:146 S. MAIN ST.
Practice Address - Street 2:STE. M
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868
Practice Address - Country:US
Practice Address - Phone:714-938-0568
Practice Address - Fax:714-938-1430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA414531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG92084-01OtherDENTICAL