Healthcare Provider Details

I. General information

NPI: 1518707934
Provider Name (Legal Business Name): JENNIFER THANH TRUC LE OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2024
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 ROSECRANS AVE
BELLFLOWER CA
90706-2246
US

IV. Provider business mailing address

8831 LAWRENCE AVE
WESTMINSTER CA
92683-7617
US

V. Phone/Fax

Practice location:
  • Phone: 562-654-2410
  • Fax:
Mailing address:
  • Phone: 562-314-7477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number35716
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: