MEDICARE: THUC DUY NGUYEN-LE PA-C

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

General Provider Information

NPI Number	:	1699571067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THUC DUY NGUYEN-LE PA-C

Provider Business Mailing Address
First Line	:	10 CONGRESS ST STE 103
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91105-3027
Country	:	US
Telephone Number	:	626-796-6164
Fax Number	:	626-796-0883

Provider Business Practice Location Address
First Line	:	10 CONGRESS ST STE 103
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91105-3027
Country	:	US
Telephone Number	:	626-796-6164
Fax Number	:	626-796-0883

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

Provider Enumeration Date	:	02/24/2025
Last Update Date	:	06/02/2026

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