MEDICARE: KHOA DAI 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	31942	CA

General Provider Information

NPI Number	:	1598891988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHOA DAI LE D.D.S.

Provider Business Mailing Address
First Line	:	8181 BOLSA AVE
Second Line	:
City	:	MIDWAY CITY
State	:	CA
Zip	:	92655-1223
Country	:	US
Telephone Number	:	714-698-8181
Fax Number	:	714-698-1609

Provider Business Practice Location Address
First Line	:	8181 BOLSA AVE
Second Line	:
City	:	MIDWAY CITY
State	:	CA
Zip	:	92655-1223
Country	:	US
Telephone Number	:	714-698-8181
Fax Number	:	714-698-1609

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

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	08/12/2016

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