MEDICARE: THIENAN LE

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	363A00000X	Physician Assistant	PA67262	CA

General Provider Information

NPI Number	:	1255147955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THIENAN LE

Provider Business Mailing Address
First Line	:	435 N 5TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85004-2157
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	222 E MCDOWELL RD APT 2001
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85004-1680
Country	:	US
Telephone Number	:	602-802-3450
Fax Number	:

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

Provider Enumeration Date	:	12/06/2024
Last Update Date	:	12/16/2025

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Directions to “ THIENAN LE ” Practice Location

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