MEDICARE: DR. PHUONG FERN LE D.M.D.

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	1223E0200X	Endodontics	51390	CA

General Provider Information

NPI Number	:	1497839856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHUONG FERN LE D.M.D.

Provider Business Mailing Address
First Line	:	65 NEILSON ST
Second Line	:	SUITE 135
City	:	WATSONVILLE
State	:	CA
Zip	:	95076-2491
Country	:	US
Telephone Number	:	831-768-9365
Fax Number	:	831-768-9393

Provider Business Practice Location Address
First Line	:	65 NEILSON ST
Second Line	:	SUITE 135
City	:	WATSONVILLE
State	:	CA
Zip	:	95076-2491
Country	:	US
Telephone Number	:	831-768-9365
Fax Number	:	831-768-9393

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	01/29/2013

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