Provider Demographics
NPI:1447641956
Name:HUNG Q. LE DDS, INC.
Entity type:Organization
Organization Name:HUNG Q. LE DDS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HUNG
Authorized Official - Middle Name:Q
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-691-1141
Mailing Address - Street 1:6360 PACIFIC AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-3723
Mailing Address - Country:US
Mailing Address - Phone:209-851-2171
Mailing Address - Fax:209-851-2176
Practice Address - Street 1:6360 PACIFIC AVE
Practice Address - Street 2:STE 2
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-3723
Practice Address - Country:US
Practice Address - Phone:209-851-2171
Practice Address - Fax:209-851-2176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization