Provider Demographics
NPI:1073631222
Name:LE, MAI KIM (DDS)
Entity type:Individual
Prefix:DR
First Name:MAI
Middle Name:KIM
Last Name:LE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1832 TULLY RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-1881
Mailing Address - Country:US
Mailing Address - Phone:408-238-8898
Mailing Address - Fax:408-270-2345
Practice Address - Street 1:1832 TULLY RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-1881
Practice Address - Country:US
Practice Address - Phone:408-238-8898
Practice Address - Fax:408-270-2345
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47633122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist