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General NPI Number Information
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NPI Number | 1619740966
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Entity Type | Individual
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Provider Name | MAI TRAN HOANG LE PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/30/2023
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Last Update Date | 11/01/2024
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Provider Practice Location Address
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Address Line | 3200 KEARNEY ST
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City | FREMONT
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State | CA
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Zip | 94538-2299
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Country | US
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Telephone | 510-498-2886
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 276950
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City | SACRAMENTO
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State | CA
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Zip | 95827-6950
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Country | US
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Telephone | 510-498-2886
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | PA64709
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA64709
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License Number State | CA
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