MEDICARE: TRAM K LE DDS INC

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	122300000X	Dentist

General Provider Information

NPI Number	:	1811559479
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRAM K LE DDS INC

Provider Business Mailing Address
First Line	:	10645 TIERRASANTA BLVD STE B
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92124-2614
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10645 TIERRASANTA BLVD STE B
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92124-2614
Country	:	US
Telephone Number	:	858-277-6080
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TRAM K LE
Credential	:	DDS
Telephone Number	:	858-277-6080

Provider Enumeration Date	:	07/03/2019
Last Update Date	:	07/03/2019

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