1003847955 NPI number — DR. KHA DANG LE JR. DMD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003847955 NPI number — DR. KHA DANG LE JR. DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LE
Provider First Name:
KHA
Provider Middle Name:
DANG
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LE
Provider Other First Name:
PATRICK
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
JR.
Provider Other Credential Text:
DMD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1003847955
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/09/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9900 MCFADDEN AVE
Provider Second Line Business Mailing Address:
#101
Provider Business Mailing Address City Name:
WESTMINSTER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92683-6978
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-531-5770
Provider Business Mailing Address Fax Number:
714-531-1427

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9900 MCFADDEN AVE
Provider Second Line Business Practice Location Address:
#101
Provider Business Practice Location Address City Name:
WESTMINSTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92683-6978
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-531-5770
Provider Business Practice Location Address Fax Number:
714-531-1427
Provider Enumeration Date:
07/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  41453 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: G9262101 . This is a "DENTI CAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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