Provider Demographics
NPI:1184627929
Name:LE, THUY D (MD)
Entity Type:Individual
Prefix:
First Name:THUY
Middle Name:D
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 1:1414 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-4806
Mailing Address - Country:US
Mailing Address - Phone:805-925-2637
Mailing Address - Fax:805-347-0033
Practice Address - Street 1:210 S PALISADE DR
Practice Address - Street 2:STE 102
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-8901
Practice Address - Country:US
Practice Address - Phone:805-928-3678
Practice Address - Fax:805-928-6408
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89145174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH82845Medicare UPIN
CAWA89145AMedicare ID - Type Unspecified