Provider Demographics
NPI:1396831210
Name:LE, CAM VAN (MD)
Entity Type:Individual
Prefix:DR
First Name:CAM
Middle Name:VAN
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 1:9341 BOLSA AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-5928
Mailing Address - Country:US
Mailing Address - Phone:714-894-9666
Mailing Address - Fax:714-894-6387
Practice Address - Street 1:9341 BOLSA AVE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5928
Practice Address - Country:US
Practice Address - Phone:714-894-9666
Practice Address - Fax:714-894-6387
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42446208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A424460Medicaid
CAA42446Medicare ID - Type Unspecified