Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 41453 | CA |
NPI | 1003847955 |
---|---|
Provider Name | Dr. Kha Dang Le JR. |
First Address | Westminster, CA 92683-6978 |
Second Address | Westminster, CA 92683-6978 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 09/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G9262101 | DENTI CAL (01) | CA |