MEDICARE: DR. TIN MINH LE D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	46283	CA

General Provider Information

NPI Number	:	1023161312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIN MINH LE D.D.S.

Provider Business Mailing Address
First Line	:	31820 ALVARADO BLVD
Second Line	:
City	:	UNION CITY
State	:	CA
Zip	:	94587-3913
Country	:	US
Telephone Number	:	510-441-2150
Fax Number	:	510-441-2151

Provider Business Practice Location Address
First Line	:	31820 ALVARADO BLVD
Second Line	:
City	:	UNION CITY
State	:	CA
Zip	:	94587-3913
Country	:	US
Telephone Number	:	510-441-2150
Fax Number	:	510-441-2151

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	07/08/2007

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