Healthcare Provider Details

I. General information

NPI: 1932599008
Provider Name (Legal Business Name): 1960 FAMILY PRACTICE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2015
Last Update Date: 01/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5039 FM 2920 RD
SPRING TX
77388-3114
US

IV. Provider business mailing address

20320 NORTHWEST FWY SUITE 900
JERSEY VILLAGE TX
77065-5641
US

V. Phone/Fax

Practice location:
  • Phone: 281-586-3888
  • Fax: 281-440-2020
Mailing address:
  • Phone: 281-586-3888
  • Fax: 281-440-2020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: HUONG LE
Title or Position: OWNER
Credential: M.D.
Phone: 281-453-7224