Healthcare Provider Details

I. General information

NPI: 1891425419
Provider Name (Legal Business Name): ANH LE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2022
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11421 WASHINGTON BLVD
WHITTIER CA
90606-3121
US

IV. Provider business mailing address

809 W WHITTIER BLVD
MONTEBELLO CA
90640-4735
US

V. Phone/Fax

Practice location:
  • Phone: 714-818-2651
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number109124
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number005315858
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: