MEDICARE: HA THI NGOC LE M.D.

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	207Q00000X	Family Medicine Physician	A51417	CA

General Provider Information

NPI Number	:	1881657468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HA THI NGOC LE M.D.

Provider Business Mailing Address
First Line	:	11525 MAMMOTH PEAK CT
Second Line	:
City	:	ALTA LOMA
State	:	CA
Zip	:	91737-6571
Country	:	US
Telephone Number	:	909-881-7320
Fax Number	:	909-881-7320

Provider Business Practice Location Address
First Line	:	4990 ARLINGTON AVE
Second Line	:	SUITE D
City	:	RIVERSIDE
State	:	CA
Zip	:	92504-2757
Country	:	US
Telephone Number	:	909-881-7320
Fax Number	:	909-881-7330

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

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	07/08/2007

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