Individual provider Active NPI

Mai Kim Le, D.D.S.

  • Dentist
  • San Jose, CA
National Provider Identifier
1073631222
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
47633 Issued in CA
Practice address
1832 Tully Rd
San Jose, CA 95122-1881
Phone
(408) 238-8898
Fax
(408) 270-2345
NPI assigned
Mar 26, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 47633 CA Primary

Addresses

Primary practice location

1832 Tully Rd
San Jose, CA 95122-1881

Mailing address

1832 Tully Rd
San Jose, CA 95122-1881
Phone (408) 238-8898

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160408001197 CA Order and Referring Only - DentistPractitioner - Dentist 1052619947

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
47633CAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
L&L Dental Care Past Accepting new patients
Le Dental Professional Corp Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1073631222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1832 TULLY RD",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951221881",
            "telephone_number": "408-238-8898",
            "fax_number": "408-270-2345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1832 TULLY RD",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951221881",
            "telephone_number": "408-238-8898",
            "fax_number": "408-270-2345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LE",
        "first_name": "MAI",
        "middle_name": "KIM",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "47633",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

Verify at the official NPI Registry.