MEDICARE: MR. BAO QUOC 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	208D00000X	General Practice Physician	A34114	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

General Provider Information

NPI Number	:	1821027418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BAO QUOC LE MD

Provider Business Mailing Address
First Line	:	2944 E ANAHEIM ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90804-3726
Country	:	US
Telephone Number	:	562-599-5777
Fax Number	:	562-433-2886

Provider Business Practice Location Address
First Line	:	2944 E ANAHEIM ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90804-3726
Country	:	US
Telephone Number	:	562-599-5777
Fax Number	:	562-433-2886

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

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	07/21/2010

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