Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 51489 | CA |
NPI | 1265560924 |
---|---|
Provider Name | Mrs. Loan Hong Le |
First Address | Fresno, CA 93722-8502 |
Second Address | San Joaquin, CA 93660 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
FHC03875F | (05) | CA |