Healthcare Provider Details

I. General information

NPI: 1740622562
Provider Name (Legal Business Name): QUY V. LE, MD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2013
Last Update Date: 10/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18111 BROOKHURST ST 2600
FOUNTAIN VALLEY CA
92708-6728
US

IV. Provider business mailing address

18111 BROOKHURST ST 2600
FOUNTAIN VALLEY CA
92708-6728
US

V. Phone/Fax

Practice location:
  • Phone: 714-861-4560
  • Fax: 714-861-4566
Mailing address:
  • Phone: 714-861-4560
  • Fax: 714-861-4566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA100948
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberA100948
License Number StateCA

VIII. Authorized Official

Name: DR. QUY V LE
Title or Position: PROVIDER
Credential: MD
Phone: 714-861-4560