1336381607 NPI number — DR. TAM CANH LE MD

Table of content: MRS. ANDREA L LOYD RN, FNP-BC (NPI 1932341302)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336381607 NPI number — DR. TAM CANH LE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LE
Provider First Name:
TAM
Provider Middle Name:
CANH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1336381607
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15521 SUNBURST LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTINGTON BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92647-2942
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-643-9442
Provider Business Mailing Address Fax Number:
714-643-9441

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9746 WESTMINSTER AVE
Provider Second Line Business Practice Location Address:
SUITE D3
Provider Business Practice Location Address City Name:
GARDEN GROVE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92844-2984
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-643-9442
Provider Business Practice Location Address Fax Number:
714-643-9441
Provider Enumeration Date:
04/01/2009

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: 207R00000X , with the licence number:  14412 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: A117637 , 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: 1336381607 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 12410527 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".




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