Provider Demographics
NPI:1942176201
Name:JOHNNY LE PLLC
Entity type:Organization
Organization Name:JOHNNY LE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:CANAVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-361-0600
Mailing Address - Street 1:27202 MAPLE VALLEY-BLACK DIAMOND RD SE
Mailing Address - Street 2:STE 104
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98003
Mailing Address - Country:US
Mailing Address - Phone:425-341-1671
Mailing Address - Fax:253-461-5493
Practice Address - Street 1:27202 MAPLE VALLEY-BLACK DIAMOND RD SE
Practice Address - Street 2:STE 104
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98003
Practice Address - Country:US
Practice Address - Phone:425-341-1671
Practice Address - Fax:253-461-5493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-14
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty