MEDICARE: DR. CHRIS LE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	A43125	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083637227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRIS LE MD

Provider Business Mailing Address
First Line	:	1433 W MERCED AVE
Second Line	:	216
City	:	WEST COVINA
State	:	CA
Zip	:	91790-3402
Country	:	US
Telephone Number	:	626-338-3553
Fax Number	:	626-338-5432

Provider Business Practice Location Address
First Line	:	1433 W MERCED AVE
Second Line	:	216
City	:	WEST COVINA
State	:	CA
Zip	:	91790-3402
Country	:	US
Telephone Number	:	626-338-3553
Fax Number	:	626-338-5432

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. CHRIS LE MD” Practice Location

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