Provider Demographics
NPI:1093810699
Name:LE, TAM HOANG (MD)
Entity Type:Individual
Prefix:
First Name:TAM
Middle Name:HOANG
Last Name:LE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 E 28TH ST STE 212
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2774
Mailing Address - Country:US
Mailing Address - Phone:562-426-5630
Mailing Address - Fax:562-492-9893
Practice Address - Street 1:701 E 28TH ST STE 212
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2774
Practice Address - Country:US
Practice Address - Phone:562-426-5630
Practice Address - Fax:562-492-9893
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87631207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ82334ZMedicaid
CA00A876310Medicaid
CAWA87631AMedicare ID - Type UnspecifiedPPIN
CAC70827Medicare UPIN
CAW13235Medicare ID - Type UnspecifiedGROUP NUMBER