Provider Demographics
NPI:1124195409
Name:LE, NGOC-LAN T (MD, DO,)
Entity Type:Individual
Prefix:
First Name:NGOC-LAN
Middle Name:T
Last Name:LE
Suffix:
Gender:F
Credentials:MD, DO,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16878 MEEKLAND AVE
Mailing Address - Street 2:# 16
Mailing Address - City:SAN LORENZO
Mailing Address - State:CA
Mailing Address - Zip Code:94580-8300
Mailing Address - Country:US
Mailing Address - Phone:510-481-7146
Mailing Address - Fax:
Practice Address - Street 1:160 CAPP ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-1210
Practice Address - Country:US
Practice Address - Phone:415-621-1170
Practice Address - Fax:415-255-7527
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A 9709207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine