Healthcare Provider Details

I. General information

NPI: 1497042055
Provider Name (Legal Business Name): LINH TUONG LE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2011
Last Update Date: 11/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3635 VISTA AVE
SAINT LOUIS MO
63110-2539
US

IV. Provider business mailing address

209 MARTIN LUTHER KING JR. WAY
TACOMA WA
98405-4267
US

V. Phone/Fax

Practice location:
  • Phone: 314-577-8776
  • Fax:
Mailing address:
  • Phone: 509-241-7195
  • Fax: 509-241-7628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberMD60462990
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: