Provider Demographics
NPI:1003395484
Name:LE, ANH TRUONG (PA-C)
Entity Type:Individual
Prefix:
First Name:ANH
Middle Name:TRUONG
Last Name:LE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:ANH
Other - Middle Name:
Other - Last Name:LE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:727 E BETHANY HOME RD STE B112
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-2151
Mailing Address - Country:US
Mailing Address - Phone:602-279-2400
Mailing Address - Fax:602-603-1302
Practice Address - Street 1:727 E BETHANY HOME RD STE D118
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2194
Practice Address - Country:US
Practice Address - Phone:602-279-2400
Practice Address - Fax:602-279-5890
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant