Provider Demographics
NPI:1265661136
Name:LE, VY-VAN (MD)
Entity Type:Individual
Prefix:
First Name:VY-VAN
Middle Name:
Last Name:LE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 PARNASSUS AVE
Mailing Address - Street 2:RM M-1180D
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0124
Mailing Address - Country:US
Mailing Address - Phone:415-502-1115
Mailing Address - Fax:415-353-9190
Practice Address - Street 1:505 PARNASSUS AVE
Practice Address - Street 2:RM M-1180D
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0124
Practice Address - Country:US
Practice Address - Phone:415-502-1115
Practice Address - Fax:415-353-9190
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-13
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 107324390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program