MEDICARE: LUU THI 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	3336C0003X	Community/Retail Pharmacy	PHY42012	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
2	0524430	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1659393593
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUU THI LE

Provider Business Mailing Address
First Line	:	392 E SANTA CLARA ST
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95113-1911
Country	:	US
Telephone Number	:	408-297-2421
Fax Number	:	408-977-0460

Provider Business Practice Location Address
First Line	:	392 E SANTA CLARA ST
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95113-1911
Country	:	US
Telephone Number	:	408-297-2421
Fax Number	:	408-977-0460

Authorized Official
Title or Position	:	MANAGER
Name	:	PAUL NGUYEN
Credential	:
Telephone Number	:	510-585-5989

Provider Enumeration Date	:	07/23/2006
Last Update Date	:	09/19/2011

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Directions to “LUU THI LE ” Practice Location

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