Healthcare Provider Details

I. General information

NPI: 1518492396
Provider Name (Legal Business Name): QUYNHCHAU HOANG LE, DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2017
Last Update Date: 04/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9938 BOLSA AVE # 106
WESTMINSTER CA
92683-6039
US

IV. Provider business mailing address

9938 BOLSA AVE # 106
WESTMINSTER CA
92683-6039
US

V. Phone/Fax

Practice location:
  • Phone: 714-531-1192
  • Fax:
Mailing address:
  • Phone: 714-531-1192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number37615
License Number StateCA

VIII. Authorized Official

Name: QUYNHCHAU HOANG LE
Title or Position: PRESIDENT
Credential: DDS
Phone: 714-531-1192