Healthcare Provider Details

I. General information

NPI: 1790197085
Provider Name (Legal Business Name): TOM L. LE, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2014
Last Update Date: 09/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 W MACARTHUR BLVD SUITE E
SANTA ANA CA
92704-7318
US

IV. Provider business mailing address

1421 W MACARTHUR BLVD SUITE E
SANTA ANA CA
92704-7318
US

V. Phone/Fax

Practice location:
  • Phone: 714-710-3030
  • Fax: 714-668-9596
Mailing address:
  • Phone: 714-710-3030
  • Fax: 714-668-9596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. TOM LONG LE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 714-710-3030