Healthcare Provider Details

I. General information

NPI: 1114861119
Provider Name (Legal Business Name): HUONG VAN LE PCC STUDENT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2026
Last Update Date: 04/18/2026
Certification Date: 04/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2670 S WHITE RD STE 200
SAN JOSE CA
95148-2073
US

IV. Provider business mailing address

1662 MANOR BLVD
SAN LEANDRO CA
94579-1509
US

V. Phone/Fax

Practice location:
  • Phone: 408-937-1553
  • Fax: 408-516-0053
Mailing address:
  • Phone: 510-612-4145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
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: