Healthcare Provider Details

I. General information

NPI: 1184816472
Provider Name (Legal Business Name): MEN THI HONG LE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2007
Last Update Date: 09/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6505 E SERRANO AVE SUITE C
ANAHEIM CA
92807-5053
US

IV. Provider business mailing address

6505 E SERRANO AVE SUITE C
ANAHEIM CA
92807-5053
US

V. Phone/Fax

Practice location:
  • Phone: 714-283-1884
  • Fax: 714-283-1836
Mailing address:
  • Phone: 714-283-1884
  • Fax: 714-283-1836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number42351
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number42351
License Number StateCA

VIII. Authorized Official

Name: DR. MEN T.H. LE
Title or Position: DR.
Credential: DMD
Phone: 714-283-1884