MEDICARE: GIA D LE MD INC

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	208VP0014X	Interventional Pain Medicine Physician	A32938	CA
2	208VP0000X	Pain Medicine Physician	A32938	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A32938	OTHER	CA	STATE LICENSE

General Provider Information

NPI Number	:	1538242763
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GIA D LE MD INC

Provider Business Mailing Address
First Line	:	17150 NEWHOPE ST
Second Line	:	STE 507
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-4250
Country	:	US
Telephone Number	:	714-437-7400
Fax Number	:	714-437-7410

Provider Business Practice Location Address
First Line	:	1523 E AMAR RD
Second Line	:	STE F
City	:	WEST COVINA
State	:	CA
Zip	:	91792-1619
Country	:	US
Telephone Number	:	626-839-9100
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GIA D. LE
Credential	:	M.D.
Telephone Number	:	626-839-9100

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	03/17/2010

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Directions to “GIA D LE MD INC ” Practice Location

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