1417042193 NPI number — DR. TRANG DIEM LE MD

Table of content: DR. TRANG DIEM LE MD (NPI 1417042193)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417042193 NPI number — DR. TRANG DIEM LE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LE
Provider First Name:
TRANG
Provider Middle Name:
DIEM
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1417042193
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/04/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
634 UPTOWN BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CEDAR HILL
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75104-3507
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-637-1300
Provider Business Mailing Address Fax Number:
866-353-7586

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
634 UPTOWN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CEDAR HILL
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75104-3507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-637-1300
Provider Business Practice Location Address Fax Number:
866-353-7586
Provider Enumeration Date:
10/04/2006

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: 207W00000X , with the licence number:  H7625 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207WX0009X , with the licence number: H7625 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0825723 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 127222106 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4460608 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 751622524 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3358824 . This is a "BCBD BLUE LINK" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0825723 . This is a "AETNA POS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 127222107 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 180021846 . This is a "MEDICARE RR DALLAS COUNTY" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 86771X . This is a "BCBS ID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0016DQ . This is a "BCBS GROUP #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 180034451 . This is a "MEDICARE RR ELLIS COUNTY" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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