Healthcare Provider Details

I. General information

NPI: 1023289329
Provider Name (Legal Business Name): THU V. LE, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 03/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 S 11TH ST SUITE 39
TACOMA WA
98405-4021
US

IV. Provider business mailing address

1212 S 11TH ST SUITE 39
TACOMA WA
98405-4021
US

V. Phone/Fax

Practice location:
  • Phone: 253-627-6128
  • Fax:
Mailing address:
  • Phone: 253-627-6128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00021181
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberMD00021181
License Number StateWA

VIII. Authorized Official

Name: THU V LE
Title or Position: OWNER
Credential: M.D.
Phone: 253-627-6128