Healthcare Provider Details

I. General information

NPI: 1467543918
Provider Name (Legal Business Name): DE HIEU LE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 10/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 13TH STREET
OAKLAND CA
94612
US

IV. Provider business mailing address

312 13TH STREET
OAKLAND CA
94612
US

V. Phone/Fax

Practice location:
  • Phone: 510-839-2758
  • Fax: 510-839-0859
Mailing address:
  • Phone: 510-839-2758
  • Fax: 510-839-0859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA35088
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License NumberA35088
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA35088
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberA35088
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA35088
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberA35088
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: