Individual
TU LE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1623 SANTA CLARA DR STE 100, ROSEVILLE, CA 95661-3589
(424) 413-1939
Mailing address
150 W SAM HOUSTON PKWY N APT 2431, HOUSTON, TX 77024-4759
(424) 413-1939
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
110029
CA
122300000X
Dentist
DN1859538
MA
1223P0300X
Periodontics
Primary
42104
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/19/2022
Last updated
02/20/2026
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