Provider Demographics
NPI:1346215597
Name:LE, DAU THANH (MD)
Entity Type:Individual
Prefix:DR
First Name:DAU
Middle Name:THANH
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 1:5444 - VIRGINIA BEACH BLVD.
Mailing Address - Street 2:SUITE 104
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462
Mailing Address - Country:US
Mailing Address - Phone:757-671-8746
Mailing Address - Fax:757-363-8626
Practice Address - Street 1:5444 - VIRGINIA BEACH BLVD.
Practice Address - Street 2:SUITE 104
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462
Practice Address - Country:US
Practice Address - Phone:757-671-8746
Practice Address - Fax:757-363-8626
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101042561207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010084156Medicaid
B74474Medicare UPIN