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General NPI Number Information
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NPI Number | 1164314902
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Entity Type | Individual
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Provider Name | ASTIN TAN-NAM LEQUANG DDS
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Gender | Male
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Dates
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Enumeration Date | 07/16/2025
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 1647 ADMIRAL TAUSSIG BLVD
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City | NORFOLK
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State | VA
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Zip | 23511-2803
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Country | US
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Telephone | 757-953-8635
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Fax |
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Provider Business Mailing Address
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Address Line | 3100 DE FOREST RD UNIT 186
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City | MARINA
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State | CA
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Zip | 93933-5308
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 14227683-9926
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License Number State | UT
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