Healthcare Provider Details

I. General information

NPI: 1851780456
Provider Name (Legal Business Name): BACH TRUNG LE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2015
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVE FL 3
SAN FRANCISCO CA
94143-2204
US

IV. Provider business mailing address

1117 E DEVONSHIRE AVE
HEMET CA
92543-3083
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-9056
  • Fax:
Mailing address:
  • Phone: 951-652-2811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number20A20341
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: