MEDICARE: ANDY PHUOC QUANG 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	207L00000X	Anesthesiology Physician	A78649	CA
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	A78649	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00140823	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00A786490	OTHER		BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659356368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDY PHUOC QUANG LE MD

Provider Business Mailing Address
First Line	:	210 N TUSTIN AVE
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-3807
Country	:	US
Telephone Number	:	714-734-7101
Fax Number	:	714-647-1245

Provider Business Practice Location Address
First Line	:	17100 EUCLID ST
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-4004
Country	:	US
Telephone Number	:	714-966-7200
Fax Number	:

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

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	02/04/2008

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