| NPI | 1740739374 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM QUOC LE Owner 714-000-0000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CA 44916) |
| Enumeration Date | 2016-09-23 |
| Last Update Date | 2017-02-02 |