Provider Demographics
NPI:1457707366
Name:LE, TIM (DDS)
Entity Type:Individual
Prefix:
First Name:TIM
Middle Name:
Last Name:LE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:CHRISTOPHER
Other - Middle Name:
Other - Last Name:TONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:10586 RICHARD RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-7873
Mailing Address - Country:US
Mailing Address - Phone:858-693-9070
Mailing Address - Fax:858-693-1521
Practice Address - Street 1:9330 MIRA MESA BLVD STE B
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4822
Practice Address - Country:US
Practice Address - Phone:858-693-9070
Practice Address - Fax:858-693-1521
Is Sole Proprietor?:No
Enumeration Date:2016-05-10
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42841122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist