Healthcare Provider Details

I. General information

NPI: 1265560924
Provider Name (Legal Business Name): LOAN HONG LE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21890 COLORADO AVE.
SAN JOAQUIN CA
93660
US

IV. Provider business mailing address

6284 W LOS ALTOS AVE
FRESNO CA
93722-8502
US

V. Phone/Fax

Practice location:
  • Phone: 559-693-2467
  • Fax: 559-693-2398
Mailing address:
  • Phone: 559-274-0879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number51489
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: