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General NPI Number Information
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NPI Number | 1902433543
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Entity Type | Individual
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Provider Name | DOMINIC LE
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Gender | Male
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Dates
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Enumeration Date | 03/24/2020
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Last Update Date | 08/01/2022
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Provider Practice Location Address
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Address Line | 2230 STOCKTON BLVD RM 202
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City | SACRAMENTO
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State | CA
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Zip | 95817-1353
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Country | US
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Telephone | 916-703-6756
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Fax |
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Provider Business Mailing Address
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Address Line | 414 BRANHAM LN E
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City | SAN JOSE
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State | CA
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Zip | 95111-2761
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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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 | A177665
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License Number State | CA
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