Healthcare Provider Details

I. General information

NPI: 1972655165
Provider Name (Legal Business Name): THIMY D. LE DMD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 WARNER AVE SUITE #160
FOUNTAIN VALLEY CA
92708-7506
US

IV. Provider business mailing address

P.O. BOX 5728
HUNTINGTON BEACH CA
92615
US

V. Phone/Fax

Practice location:
  • Phone: 714-799-9945
  • Fax: 657-218-9699
Mailing address:
  • Phone: 714-799-9945
  • Fax: 714-799-9505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number48943
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number48943
License Number StateCA

VIII. Authorized Official

Name: DR. THIMY D LE
Title or Position: DENTIST
Credential: DMD
Phone: 714-799-9945