Healthcare Provider Details

I. General information

NPI: 1558942367
Provider Name (Legal Business Name): HUNG THANH LE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 07/05/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

785 HANA WAY STE 101
FOLSOM CA
95630-3885
US

IV. Provider business mailing address

785 HANA WAY STE 101
FOLSOM CA
95630-3885
US

V. Phone/Fax

Practice location:
  • Phone: 916-817-8937
  • Fax: 916-817-8937
Mailing address:
  • Phone:
  • Fax: 916-817-8937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDDS108514
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: