Provider Demographics
NPI:1770766545
Name:KHOA DAI LE DDS INC
Entity type:Organization
Organization Name:KHOA DAI LE DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KHOA
Authorized Official - Middle Name:DAI
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-698-8181
Mailing Address - Street 1:8181 BOLSA AVE
Mailing Address - Street 2:
Mailing Address - City:MIDWAY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92655-1223
Mailing Address - Country:US
Mailing Address - Phone:714-698-8181
Mailing Address - Fax:714-698-1609
Practice Address - Street 1:8181 BOLSA AVE
Practice Address - Street 2:
Practice Address - City:MIDWAY CITY
Practice Address - State:CA
Practice Address - Zip Code:92655
Practice Address - Country:US
Practice Address - Phone:714-698-8181
Practice Address - Fax:714-698-1609
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KHOA DAI LE DDS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-14
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31942122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty