Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 54007 | CA |
N | 204E00000X | Oral & Maxillofacial Surgeon | A113863 | CA |
NPI | 1487980819 |
---|---|
Provider Name | Hung Le |
First Address | Anaheim, CA 92804-1853 |
Second Address | Anaheim, CA 92804-1853 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2009 |
Last Update Date | 29/06/2012 |