Healthcare Provider Details

I. General information

NPI: 1205465135
Provider Name (Legal Business Name): ANDREW JAMES LE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 10/15/2024
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 SUPERIOR AVE STE 200B200D
NEWPORT BEACH CA
92663-3663
US

IV. Provider business mailing address

14350 MERIDIAN PKWY # 2
RIVERSIDE CA
92518-3035
US

V. Phone/Fax

Practice location:
  • Phone: 949-791-3001
  • Fax: 949-791-3096
Mailing address:
  • Phone: 951-827-7669
  • 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 Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA186664
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: