Healthcare Provider Details

I. General information

NPI: 1265061626
Provider Name (Legal Business Name): PHUONGANH MINH LE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOAG DR
NEWPORT BEACH CA
92663-4162
US

IV. Provider business mailing address

361 HOSPITAL RD STE 521
NEWPORT BEACH CA
92663-3526
US

V. Phone/Fax

Practice location:
  • Phone: 949-873-6181
  • Fax: 949-873-6181
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA1836644
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA1836644
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: