Healthcare Provider Details

I. General information

NPI: 1902828569
Provider Name (Legal Business Name): DANIEL QUOC LE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 12/09/2019
Certification Date: 12/09/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 S MAIN ST STE 200
ORANGE CA
92868-3852
US

IV. Provider business mailing address

PO BOX 53964
IRVINE CA
92619-3964
US

V. Phone/Fax

Practice location:
  • Phone: 714-634-4567
  • Fax:
Mailing address:
  • Phone: 949-574-5100
  • Fax: 949-574-5138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberG71070
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberG71070
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: