=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316698160
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAU T. LE, M.D., LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2022
-----------------------------------------------------
Last Update Date | 01/13/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5444 VIRGINIA BEACH BLVD STE 104
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23462-1758
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-671-8746
-----------------------------------------------------
Fax | 757-363-8626
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5444 VIRGINIA BEACH BLVD STE 104
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23462-1758
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-671-8746
-----------------------------------------------------
Fax | 757-363-8626
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. DAU THANH LE
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 757-671-8746
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------