Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 40165 | CA |
Y | 204E00000X | Oral & Maxillofacial Surgeon | DS039275 | PA |
NPI | 1255522793 |
---|---|
Provider Name | Dr. Anh D. Le |
First Address | Philadelphia, PA 19104 |
Second Address | Philadelphia, PA 19104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2007 |
Last Update Date | 24/10/2012 |