Healthcare Provider Details

I. General information

NPI: 1467427781
Provider Name (Legal Business Name): NGUYEN NHU LE D.M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 11/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11437 MIRO CIR
SAN DIEGO CA
92131-3316
US

IV. Provider business mailing address

11437 MIRO CIR
SAN DIEGO CA
92131-3316
US

V. Phone/Fax

Practice location:
  • Phone: 858-692-5951
  • Fax:
Mailing address:
  • Phone: 858-692-5951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number55607
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberKY 7739
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: