Provider Demographics
NPI:1194748889
Name:LE, KEVIN T
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:T
Last Name:LE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4575 NE 4TH ST
Mailing Address - Street 2:SUITE #5
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-5054
Mailing Address - Country:US
Mailing Address - Phone:425-793-5814
Mailing Address - Fax:
Practice Address - Street 1:4575 NE 4TH ST
Practice Address - Street 2:SUITE #5
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98059-5054
Practice Address - Country:US
Practice Address - Phone:425-793-5814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE85181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice