Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 44005 | CA |
NPI | 1073769022 |
---|---|
Provider Name | Dr. Khang Tuong Le |
First Address | Santa Ana, CA 92704-7463 |
Second Address | Santa Ana, CA 92704-7463 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2008 |
Last Update Date | 10/03/2011 |