Healthcare Provider Details

I. General information

NPI: 1649555293
Provider Name (Legal Business Name): HELEN HUONG LE MANGUNE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HUONG HELEN THANH LE PA-C

II. Dates (important events)

Enumeration Date: 10/14/2011
Last Update Date: 06/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16660 PARAMOUNT BLVD
PARAMOUNT CA
90723-5433
US

IV. Provider business mailing address

5606 LAKEWOOD AVENUE
LAKEWOOD CA
90712
US

V. Phone/Fax

Practice location:
  • Phone: 562-480-7288
  • Fax:
Mailing address:
  • Phone: 818-300-5394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: