Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 63890 | CA |
NPI | 1003235631 |
---|---|
Provider Name | Dr. Nick L. Le |
First Address | Rancho Cucamonga, CA 91739-9126 |
Second Address | San Bernardino, CA 92408-3406 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2014 |
Last Update Date | 01/06/2020 |