MEDICARE: THAO LE

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	43710	CA

General Provider Information

NPI Number	:	1528115797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THAO LE

Provider Business Mailing Address
First Line	:	2175 TULLY RD
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95122-1346
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2175 TULLY RD
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95122-1346
Country	:	US
Telephone Number	:	408-272-7171
Fax Number	:

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

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	07/08/2007

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Directions to “ THAO LE ” Practice Location

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