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General NPI Number Information
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NPI Number | 1790343887
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Entity Type | Individual
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Provider Name | CHRISTOPHER MINH TAN LE DO
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Gender | Male
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Dates
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Enumeration Date | 06/03/2019
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Last Update Date | 04/15/2024
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Provider Practice Location Address
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Address Line | 19800 HALL RD
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City | CLINTON TWP
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State | MI
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Zip | 48038-5318
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Country | US
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Telephone | 855-996-2264
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Fax |
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Provider Business Mailing Address
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Address Line | 2548 HIGHRIDGE DR
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City | CHINO HILLS
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State | CA
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Zip | 91709-4890
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 20A21164
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 5151013784
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License Number State | MI
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