MEDICARE: MICHAEL M. LE D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	50075	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013131440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL M. LE D.D.S

Provider Business Mailing Address
First Line	:	138 DOLCI
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92602-1880
Country	:	US
Telephone Number	:	310-749-6446
Fax Number	:

Provider Business Practice Location Address
First Line	:	2150 E SOUTH ST
Second Line	:	STE. 116
City	:	LONG BEACH
State	:	CA
Zip	:	90805-4457
Country	:	US
Telephone Number	:	562-531-9779
Fax Number	:	562-531-9779

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	06/23/2021

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