Healthcare Provider Details

I. General information

NPI: 1891406989
Provider Name (Legal Business Name): BRANDON QUOC LE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2022
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date: 11/23/2024
Reactivation Date: 12/04/2024

III. Provider practice location address

11869 VALLEY VIEW ST
GARDEN GROVE CA
92845-1236
US

IV. Provider business mailing address

12661 LORNA ST APT D
GARDEN GROVE CA
92841-4574
US

V. Phone/Fax

Practice location:
  • Phone: 657-239-4840
  • Fax:
Mailing address:
  • Phone: 714-461-2469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: