Provider Demographics
NPI:1023015641
Name:LE, THUY-TIEN V (DO)
Entity Type:Individual
Prefix:DR
First Name:THUY-TIEN
Middle Name:V
Last Name:LE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1884
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WA
Mailing Address - Zip Code:98354-1884
Mailing Address - Country:US
Mailing Address - Phone:702-871-8535
Mailing Address - Fax:941-499-0035
Practice Address - Street 1:732 BROADWAY STE 201
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-3702
Practice Address - Country:US
Practice Address - Phone:702-871-8535
Practice Address - Fax:941-499-0035
Is Sole Proprietor?:No
Enumeration Date:2005-06-29
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001863207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8480089Medicaid
WA1117597Medicaid
WAG8804129Medicare PIN
WA1117597Medicaid
WAG8863585Medicare ID - Type Unspecified