Provider Demographics
NPI:1023364122
Name:LE, LINH PHUONG HOANG
Entity Type:Individual
Prefix:MISS
First Name:LINH PHUONG
Middle Name:HOANG
Last Name:LE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5155 CENTRAL AVE
Mailing Address - Street 2:# 24
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-1818
Mailing Address - Country:US
Mailing Address - Phone:951-275-4649
Mailing Address - Fax:
Practice Address - Street 1:1745 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-5343
Practice Address - Country:US
Practice Address - Phone:951-684-5661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA99588183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician