Provider Demographics
NPI:1487980819
Name:LE, HUNG (MD)
Entity type:Individual
Prefix:
First Name:HUNG
Middle Name:
Last Name:LE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 S BEACH BLVD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-1853
Mailing Address - Country:US
Mailing Address - Phone:714-220-0964
Mailing Address - Fax:
Practice Address - Street 1:408 S BEACH BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-1853
Practice Address - Country:US
Practice Address - Phone:714-220-0964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-20
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA113863204E00000X
CA540071223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery