Healthcare Provider Details

I. General information

NPI: 1417210204
Provider Name (Legal Business Name): TUAN MANH LE P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2012
Last Update Date: 11/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9191 WESTMINSTER AVE
GARDEN GROVE CA
92844-2751
US

IV. Provider business mailing address

9191 WESTMINSTER AVE
GARDEN GROVE CA
92844-2751
US

V. Phone/Fax

Practice location:
  • Phone: 714-899-2000
  • Fax: 714-899-0051
Mailing address:
  • Phone: 714-899-2000
  • Fax: 714-899-0051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA15503
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: