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General NPI Number Information
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NPI Number | 1073769022
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Entity Type | Individual
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Provider Name | KHANG TUONG LE D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 08/11/2008
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Last Update Date | 03/10/2011
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Provider Practice Location Address
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Address Line | 3755 S PLAZA DR
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City | SANTA ANA
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State | CA
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Zip | 92704-7463
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Country | US
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Telephone | 310-257-8043
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Fax | 310-257-1155
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Provider Business Mailing Address
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Address Line | 3755 S PLAZA DR
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City | SANTA ANA
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State | CA
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Zip | 92704-7463
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Country | US
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Telephone | 310-809-7211
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 44005
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License Number State | CA
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