MEDICARE: QUYNHCHAU HOANG LE, DDS, INC.

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	37615	CA

General Provider Information

NPI Number	:	1518492396
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUYNHCHAU HOANG LE, DDS, INC.

Provider Business Mailing Address
First Line	:	9938 BOLSA AVE
Second Line	:	# 106
City	:	WESTMINSTER
State	:	CA
Zip	:	92683-6039
Country	:	US
Telephone Number	:	714-531-1192
Fax Number	:

Provider Business Practice Location Address
First Line	:	9938 BOLSA AVE
Second Line	:	# 106
City	:	WESTMINSTER
State	:	CA
Zip	:	92683-6039
Country	:	US
Telephone Number	:	714-531-1192
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	QUYNHCHAU HOANG LE
Credential	:	DDS
Telephone Number	:	714-531-1192

Provider Enumeration Date	:	04/28/2017
Last Update Date	:	04/28/2017

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