MEDICARE: JENNY LE

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	1223P0700X	Prosthodontics	64128	CA

General Provider Information

NPI Number	:	1437690385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNY LE

Provider Business Mailing Address
First Line	:	9900 MCFADDEN AVE STE 204
Second Line	:
City	:	WESTMINSTER
State	:	CA
Zip	:	92683-6978
Country	:	US
Telephone Number	:	714-852-3357
Fax Number	:

Provider Business Practice Location Address
First Line	:	9900 MCFADDEN AVE STE 204
Second Line	:
City	:	WESTMINSTER
State	:	CA
Zip	:	92683-6978
Country	:	US
Telephone Number	:	714-852-3357
Fax Number	:

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

Provider Enumeration Date	:	03/12/2017
Last Update Date	:	09/20/2018

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Directions to “ JENNY LE ” Practice Location

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