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General NPI Number Information
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NPI Number | 1306180708
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Entity Type | Individual
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Provider Name | KY TRONG LE D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/26/2012
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Last Update Date | 11/26/2012
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Provider Practice Location Address
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Address Line | 2005 KNIGHT LANE NAVY MEDICINE SUPPORT COMMAND,, BLDG H
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City | JACKSONVILLE
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State | FL
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Zip | 32212-0140
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Country | US
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Telephone | 619-453-8600
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Fax |
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Provider Business Mailing Address
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Address Line | 1612 MARINE AVE
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City | GARDENA
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State | CA
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Zip | 90247-3108
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Country | US
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Telephone | 310-951-0579
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 8434722-9921
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License Number State | UT
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