MEDICARE: DR. HAO ANH LE DDS

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	1223G0001X	General Practice Dentistry	5552	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5552	OTHER	AZ	DENTIST

General Provider Information

NPI Number	:	1053432617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HAO ANH LE DDS

Provider Business Mailing Address
First Line	:	9690 PUFFIN AVE
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-5847
Country	:	US
Telephone Number	:	480-206-4358
Fax Number	:

Provider Business Practice Location Address
First Line	:	14341 BEACH BLVD STE I
Second Line	:
City	:	WESTMINSTER
State	:	CA
Zip	:	92683-4561
Country	:	US
Telephone Number	:	623-845-7400
Fax Number	:	623-245-4159

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

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	11/13/2018

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