Healthcare Provider Details

I. General information

NPI: 1821425497
Provider Name (Legal Business Name): KHOI LE, D.D.S INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2013
Last Update Date: 09/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

889 SUNSET DR A
HOLLISTER CA
95023-5601
US

IV. Provider business mailing address

889 SUNSET DR A
HOLLISTER CA
95023-5601
US

V. Phone/Fax

Practice location:
  • Phone: 831-637-9122
  • Fax: 831-637-2612
Mailing address:
  • Phone: 831-637-9122
  • Fax: 831-637-2612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number58147
License Number StateCA

VIII. Authorized Official

Name: KHOI DINH LE
Title or Position: DENTIST/OWNER
Credential: D.D.S.
Phone: 831-637-9122