Healthcare Provider Details

I. General information

NPI: 1124201181
Provider Name (Legal Business Name): LUAN T. LE, D.D.S. , INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2007
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3151 S WHITE RD SUITE 204
SAN JOSE CA
95148-4045
US

IV. Provider business mailing address

3151 S WHITE RD SUITE 204
SAN JOSE CA
95148-4045
US

V. Phone/Fax

Practice location:
  • Phone: 408-270-1120
  • Fax: 408-270-1026
Mailing address:
  • Phone: 408-270-1120
  • Fax: 408-270-1026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number39029
License Number StateCA

VIII. Authorized Official

Name: DR. LUAN T LE
Title or Position: DENTIST
Credential: D.D.S.
Phone: 408-270-1120