MEDICARE: NAM QUOC LE D.O.

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207R00000X	Internal Medicine Physician	20A12155	CA

General Provider Information

NPI Number	:	1750607644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAM QUOC LE D.O.

Provider Business Mailing Address
First Line	:	14772 WILSON ST
Second Line	:
City	:	MIDWAY CITY
State	:	CA
Zip	:	92655-1364
Country	:	US
Telephone Number	:	909-838-0679
Fax Number	:

Provider Business Practice Location Address
First Line	:	14772 WILSON ST
Second Line	:
City	:	MIDWAY CITY
State	:	CA
Zip	:	92655-1364
Country	:	US
Telephone Number	:	909-838-0679
Fax Number	:

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

Provider Enumeration Date	:	04/16/2010
Last Update Date	:	02/07/2022

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