1972817138 NPI number — CHINH T. LE FNP-C

Table of content: CHINH T. LE FNP-C (NPI 1972817138)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972817138 NPI number — CHINH T. LE FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LE
Provider First Name:
CHINH
Provider Middle Name:
T.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972817138
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9243 ALMONDWILLOW WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELK GROVE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95624-5402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-428-3788
Provider Business Mailing Address Fax Number:
916-428-0788

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7275 E SOUTHGATE DR
Provider Second Line Business Practice Location Address:
204
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95823-2628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-428-3788
Provider Business Practice Location Address Fax Number:
916-428-0788
Provider Enumeration Date:
07/29/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  18713 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 18713 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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