MEDICARE: DR. DAN D LE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	C158790	CA
2	207RI0011X	Interventional Cardiology Physician	C158790	CA
3	207UN0901X	Nuclear Cardiology Physician	C158790	CA
4	207RC0000X	Cardiovascular Disease Physician	C158790	CA

General Provider Information

NPI Number	:	1912214347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAN D LE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 20259
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92728-0259
Country	:	US
Telephone Number	:	718-974-0148
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 BOLSA AVE STE P
Second Line	:
City	:	WESTMINSTER
State	:	CA
Zip	:	92683-5943
Country	:	US
Telephone Number	:	714-714-0075
Fax Number	:	833-699-2097

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2010
Last Update Date	:	09/13/2021

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