Provider Demographics
NPI:1194814343
Name:LE, PHILLIP DINH (MD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:DINH
Last Name:LE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1910 W SUNSET BLVD
Mailing Address - Street 2:SUITE 650
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-3290
Mailing Address - Country:US
Mailing Address - Phone:213-484-1186
Mailing Address - Fax:213-413-3443
Practice Address - Street 1:1910 W SUNSET BLVD
Practice Address - Street 2:SUITE 650
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-3290
Practice Address - Country:US
Practice Address - Phone:213-484-1186
Practice Address - Fax:213-413-3443
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66633207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A666330Medicaid
CA00A666330Medicaid
WA66633CMedicare ID - Type Unspecified