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General NPI Number Information
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NPI Number | 1942176201
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Entity Type | Organization
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Legal Business Name | JOHNNY LE PLLC
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Dates
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Enumeration Date | 10/14/2025
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Last Update Date | 10/14/2025
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Provider Practice Location Address
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Address Line | 27202 MAPLE VALLEY-BLACK DIAMOND RD SE STE 104
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City | MAPLE VALLEY
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State | WA
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Zip | 98003
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Country | US
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Telephone | 425-341-1671
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Fax | 253-461-5493
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Provider Business Mailing Address
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Address Line | 27202 MAPLE VALLEY-BLACK DIAMOND RD SE STE 104
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City | MAPLE VALLEY
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State | WA
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Zip | 98003
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Country | US
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Telephone | 425-341-1671
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Fax | 253-461-5493
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Authorized Official
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Title or Position | VP REVENUE CYCLE
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Name | CAROL CANAVA
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Credential |
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Telephone | 972-361-0600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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