MEDICARE: DENTAL OFFICE OF LE NGUYEN KIM 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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1881557627
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL OFFICE OF LE NGUYEN KIM INC

Provider Business Mailing Address
First Line	:	2915 E FLORENCE AVE
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-5825
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2915 E FLORENCE AVE
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-5825
Country	:	US
Telephone Number	:	323-585-7777
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DUSTIN LE
Credential	:
Telephone Number	:	323-585-7777

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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