=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821425497
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KHOI LE, D.D.S INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2013
-----------------------------------------------------
Last Update Date | 09/27/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 889 SUNSET DR A
-----------------------------------------------------
City | HOLLISTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95023-5601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-637-9122
-----------------------------------------------------
Fax | 831-637-2612
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 889 SUNSET DR A
-----------------------------------------------------
City | HOLLISTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95023-5601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-637-9122
-----------------------------------------------------
Fax | 831-637-2612
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST/OWNER
-----------------------------------------------------
Name | KHOI DINH LE
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 831-637-9122
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 58147
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------