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General NPI Number Information
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NPI Number | 1972030518
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Entity Type | Organization
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Legal Business Name | ESTHER KIM LE RDHAP, INC
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Dates
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Enumeration Date | 05/14/2017
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Last Update Date | 05/14/2017
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Provider Practice Location Address
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Address Line | 15251 KENSINGTON PARK DR
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City | TUSTIN
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State | CA
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Zip | 92782-1807
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Country | US
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Telephone | 714-260-2259
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4772
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City | GARDEN GROVE
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State | CA
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Zip | 92842-4772
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Country | US
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Telephone | 714-260-2259
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ESTHER KIM LE
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Credential | RDHAP
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Telephone | 714-260-2259
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 616
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License Number State | CA
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