MEDICARE: DR. KENNETH T 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	43457	CA
2	122300000X	Dentist	4586T	NV

General Provider Information

NPI Number	:	1457459406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH T LE D.D.S

Provider Business Mailing Address
First Line	:	28 BRANDERMILL DR
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-6600
Country	:	US
Telephone Number	:	714-269-2088
Fax Number	:

Provider Business Practice Location Address
First Line	:	6020 BADURA AVE STE 120
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-4716
Country	:	US
Telephone Number	:	702-880-4266
Fax Number	:	702-792-4266

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	09/27/2018

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