Healthcare Provider Details

I. General information

NPI: 1609230523
Provider Name (Legal Business Name): THUY BICH LE, DDS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2016
Last Update Date: 04/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

391 S STATE COLLEGE BLVD SUITE M
BREA CA
92821-5755
US

IV. Provider business mailing address

391 S STATE COLLEGE BLVD SUITE M
BREA CA
92821-5755
US

V. Phone/Fax

Practice location:
  • Phone: 714-990-3321
  • Fax: 714-990-3546
Mailing address:
  • Phone: 714-990-3321
  • Fax: 714-990-3546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number49357
License Number StateCA

VIII. Authorized Official

Name: DR. THUY BICH LE
Title or Position: OWNER
Credential: DDS
Phone: 714-990-3321