Provider Demographics
NPI:1154330058
Name:LE, GIAO VAN (MD)
Entity Type:Individual
Prefix:DR
First Name:GIAO
Middle Name:VAN
Last Name:LE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8130 MCFADDEN AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-7109
Mailing Address - Country:US
Mailing Address - Phone:714-373-4311
Mailing Address - Fax:714-897-2474
Practice Address - Street 1:8130 MCFADDEN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-7109
Practice Address - Country:US
Practice Address - Phone:714-373-4311
Practice Address - Fax:714-897-2474
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0A364562085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A364561Medicaid
CAA36456Medicare ID - Type Unspecified
CA00A364561Medicaid