Provider Demographics
NPI:1194918987
Name:LE, KHOI
Entity type:Individual
Prefix:
First Name:KHOI
Middle Name:
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 1:889 SUNSET DR STE A
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-5601
Mailing Address - Country:US
Mailing Address - Phone:831-637-9122
Mailing Address - Fax:831-637-2612
Practice Address - Street 1:889 SUNSET DR STE A
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-5601
Practice Address - Country:US
Practice Address - Phone:831-637-9122
Practice Address - Fax:831-637-2612
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58147122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist