Provider Demographics
NPI:1053439471
Name:LE, CUC KIM (DDS)
Entity type:Individual
Prefix:DR
First Name:CUC
Middle Name:KIM
Last Name:LE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2664 BERRYESSA RD STE 114
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95132-2906
Mailing Address - Country:US
Mailing Address - Phone:408-254-4346
Mailing Address - Fax:408-254-4356
Practice Address - Street 1:2664 BERRYESSA RD STE 114
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95132-2906
Practice Address - Country:US
Practice Address - Phone:408-254-4346
Practice Address - Fax:408-254-4356
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33206122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist