Healthcare Provider Details

I. General information

NPI: 1144598897
Provider Name (Legal Business Name): CAM VAN LE,MD,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2011
Last Update Date: 12/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9341 BOLSA AVE
WESTMINSTER CA
92683-5928
US

IV. Provider business mailing address

9341 BOLSA AVE
WESTMINSTER CA
92683-5928
US

V. Phone/Fax

Practice location:
  • Phone: 714-894-9666
  • Fax: 714-894-6387
Mailing address:
  • Phone: 714-894-9666
  • Fax: 714-894-6387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA42446
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA42446
License Number StateCA

VIII. Authorized Official

Name: CAM VAN LE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 714-894-9666