Provider Demographics
NPI:1144216425
Name:LE, TIEN HUNG SON (DPM)
Entity Type:Individual
Prefix:DR
First Name:TIEN
Middle Name:HUNG SON
Last Name:LE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3777 JAMES COURT
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701
Mailing Address - Country:US
Mailing Address - Phone:740-450-3294
Mailing Address - Fax:740-450-3295
Practice Address - Street 1:3777 JAMES COURT
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701
Practice Address - Country:US
Practice Address - Phone:740-450-3294
Practice Address - Fax:740-450-3295
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002921213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000122961OtherANTHEM
OH2110236Medicaid
OH0822606Medicare PIN
OH2110236Medicaid
OHU66222Medicare UPIN
OH1447270897Medicare NSC
OH1319640001Medicare NSC
OH1043393226Medicare NSC
OH1319640002Medicare NSC
OH000000122961OtherANTHEM