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General NPI Number Information
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NPI Number | 1699871202
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Entity Type | Organization
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Legal Business Name | GRAND CINCO MEDICAL CLINIC, P.A.
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2830 COMMERCIAL CENTER BLVD STE 102
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City | KATY
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State | TX
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Zip | 77494-6405
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Country | US
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Telephone | 281-693-1700
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Fax | 281-693-1712
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Provider Business Mailing Address
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Address Line | 2830 COMMERCIAL CENTER BLVD STE 102
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City | KATY
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State | TX
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Zip | 77494-6405
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Country | US
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Telephone | 281-693-1700
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Fax | 281-693-1712
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. HUNG VIET LE
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Credential | M.D.
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Telephone | 281-693-1700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | J4293
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License Number State | TX
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