Provider Demographics
NPI:1366864860
Name:LE, SI DUNG (DC)
Entity Type:Individual
Prefix:DR
First Name:SI
Middle Name:DUNG
Last Name:LE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5380 WEST LN
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-3522
Mailing Address - Country:US
Mailing Address - Phone:209-477-7777
Mailing Address - Fax:408-519-6675
Practice Address - Street 1:5380 WEST LN
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-3522
Practice Address - Country:US
Practice Address - Phone:209-477-7777
Practice Address - Fax:408-519-6675
Is Sole Proprietor?:No
Enumeration Date:2014-01-17
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32787111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor