Healthcare Provider Details

I. General information

NPI: 1770526931
Provider Name (Legal Business Name): DZUNG T LE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UCSD MEDICAL CENTER 200 WEST ARBOR DRIVE MC 8201
SAN DIEGO CA
92103-8201
US

IV. Provider business mailing address

PO BOX 232410
SAN DIEGO CA
92193-2410
US

V. Phone/Fax

Practice location:
  • Phone: 858-534-8048
  • Fax: 858-534-4715
Mailing address:
  • Phone: 858-249-6749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License NumberG71291
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: