Healthcare Provider Details

I. General information

NPI: 1467346932
Provider Name (Legal Business Name): LYNA DANG LE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2025
Last Update Date: 06/07/2025
Certification Date: 06/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 RIVER OAKS PKWY
SAN JOSE CA
95134-1907
US

IV. Provider business mailing address

100 BRANHAM LN E APT 1112
SAN JOSE CA
95111-3859
US

V. Phone/Fax

Practice location:
  • Phone: 408-914-3851
  • Fax:
Mailing address:
  • Phone: 669-225-1713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: