Provider Demographics
NPI:1811175698
Name:KHANH UYEN LE, D.M.D., P.C.
Entity type:Organization
Organization Name:KHANH UYEN LE, D.M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KHANH
Authorized Official - Middle Name:UYEN
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:703-534-6226
Mailing Address - Street 1:2946 SLEEPY HOLLOW RD
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044-2003
Mailing Address - Country:US
Mailing Address - Phone:703-534-6226
Mailing Address - Fax:703-534-6228
Practice Address - Street 1:2946 SLEEPY HOLLOW RD
Practice Address - Street 2:SUITE 1B
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-2003
Practice Address - Country:US
Practice Address - Phone:703-534-6226
Practice Address - Fax:703-534-6228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014107181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0018056Medicaid
MD4046161Medicaid