=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760102933
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL BUU NGOC LE DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2022
-----------------------------------------------------
Last Update Date | 08/29/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12460 EUCLID ST STE 102
-----------------------------------------------------
City | GARDEN GROVE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92840-3351
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-638-4852
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3880 W KENT AVE UNIT 7
-----------------------------------------------------
City | SANTA ANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92704-2389
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-657-4755
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC36414
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------