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General NPI Number Information
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NPI Number | 1255577086
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Entity Type | Organization
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Legal Business Name | KHA DANG LE AND ANNE HANGMAN LE DMD INC
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Dates
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Enumeration Date | 12/29/2008
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Last Update Date | 12/29/2008
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Provider Practice Location Address
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Address Line | 2150 N WATERMAN AVE SUITE # 103
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City | SAN BERNARDINO
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State | CA
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Zip | 92404
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Country | US
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Telephone | 909-882-7974
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Fax | 909-713-0160
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Provider Business Mailing Address
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Address Line | 2150 N WATERMAN AVE SUITE # 103
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City | SAN BERNARDINO
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State | CA
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Zip | 92404
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Country | US
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Telephone | 909-882-7974
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Fax | 909-713-0160
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Authorized Official
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Title or Position | OWNER
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Name | DR. KHA DANG LE
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Credential | DMD
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Telephone | 909-882-7974
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 41453
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License Number State | CA
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