Healthcare Provider Details

I. General information

NPI: 1598708117
Provider Name (Legal Business Name): THINH T. LE DPM INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 03/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1238 E ARROW HWY
UPLAND CA
91786-4951
US

IV. Provider business mailing address

903 WOODSPRING PL
DIAMOND BAR CA
91765-4385
US

V. Phone/Fax

Practice location:
  • Phone: 909-982-0099
  • Fax: 909-931-0402
Mailing address:
  • Phone: 909-860-8421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberE4208
License Number StateCA

VIII. Authorized Official

Name: DR. THINH TRUNG LE
Title or Position: CEO
Credential: DPM
Phone: 909-319-4861