MEDICARE: CATHERINE 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	1223G0001X	General Practice Dentistry	41847	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	820211	OTHER	CA	UNITED CONCORDIA

General Provider Information

NPI Number	:	1639392921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CATHERINE LE, DDS, INC.

Provider Business Mailing Address
First Line	:	2171 ULRIC ST
Second Line	:	SUITE 100
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-6690
Country	:	US
Telephone Number	:	858-268-8188
Fax Number	:	858-268-2864

Provider Business Practice Location Address
First Line	:	2171 ULRIC ST
Second Line	:	SUITE 100
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-6690
Country	:	US
Telephone Number	:	858-268-8188
Fax Number	:	858-268-2864

Authorized Official
Title or Position	:	D.D.S
Name	:	DR. CATHERINE LE
Credential	:
Telephone Number	:	858-268-8188

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	06/21/2018

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