Healthcare Provider Details

I. General information

NPI: 1386282010
Provider Name (Legal Business Name): VY TUONG LE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2019
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23141 MOULTON PKWY STE 210
LAGUNA HILLS CA
92653-1204
US

IV. Provider business mailing address

45 PATRICIA LN
SOUTH SETAUKET NY
11720-1246
US

V. Phone/Fax

Practice location:
  • Phone: 858-859-5678
  • Fax:
Mailing address:
  • Phone: 858-859-5678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number108725
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: