Provider Demographics
NPI:1982122099
Name:LE, KEVIN DINH HIEU
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:DINH HIEU
Last Name:LE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5530 KNIGHTS VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-8780
Mailing Address - Country:US
Mailing Address - Phone:559-916-9284
Mailing Address - Fax:
Practice Address - Street 1:771 E HORIZON DR STE 176
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-8408
Practice Address - Country:US
Practice Address - Phone:559-916-9284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101977122300000X
NV7505122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist