Healthcare Provider Details

I. General information

NPI: 1174760136
Provider Name (Legal Business Name): NGOC LE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2009
Last Update Date: 03/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2488 DE LA CRUZ BLVD
SANTA CLARA CA
95050-2923
US

IV. Provider business mailing address

246 SOBRANTE WAY
SUNNYVALE CA
94086-4807
US

V. Phone/Fax

Practice location:
  • Phone: 408-247-7278
  • Fax: 408-247-9320
Mailing address:
  • Phone: 408-733-3670
  • Fax: 408-245-7968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 35319
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: