MEDICARE: VIET LE DDS

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	DR60757069	WA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	122300000X	Dentist	102818	CA

General Provider Information

NPI Number	:	1831638329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIET LE DDS

Provider Business Mailing Address
First Line	:	5102 STREAMVIEW DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92105-3202
Country	:	US
Telephone Number	:	619-717-7448
Fax Number	:

Provider Business Practice Location Address
First Line	:	2020 CAMINO DEL RIO N STE 108
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-1542
Country	:	US
Telephone Number	:	619-220-8545
Fax Number	:	760-940-9464

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

Provider Enumeration Date	:	02/16/2017
Last Update Date	:	06/27/2023

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Directions to “ VIET LE DDS” Practice Location

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