1316183452 NPI number — WILLIAM LE

Table of content: WILLIAM LE (NPI 1316183452)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316183452 NPI number — WILLIAM LE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LE
Provider First Name:
WILLIAM
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LE
Provider Other First Name:
HUY-DUNG LE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1316183452
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11941 ROBERT LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARDEN GROVE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92840-2542
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-655-8578
Provider Business Mailing Address Fax Number:
425-920-6329

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9143 VALLEY BLVD STE 101B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSEMEAD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91770-1993
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-237-0135
Provider Business Practice Location Address Fax Number:
626-237-0136
Provider Enumeration Date:
12/19/2008

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: 363A00000X , with the licence number:  PA20119 , 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: 010648400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com