Healthcare Provider Details

I. General information

NPI: 1063096477
Provider Name (Legal Business Name): DAN LE CARDIOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 05/11/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 BOLSA AVE UNIT P
WESTMINSTER CA
92683-5943
US

IV. Provider business mailing address

PO BOX 20259
FOUNTAIN VALLEY CA
92728-0259
US

V. Phone/Fax

Practice location:
  • Phone: 714-714-0075
  • Fax: 833-699-2097
Mailing address:
  • Phone: 714-714-0075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAN LE
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 714-714-0075