Provider Demographics
NPI:1396842704
Name:LE, THUAN (MD)
Entity Type:Individual
Prefix:DR
First Name:THUAN
Middle Name:
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:PO BOX 890939
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92589-0939
Mailing Address - Country:US
Mailing Address - Phone:951-679-5811
Mailing Address - Fax:951-679-5844
Practice Address - Street 1:28078 BAXTER RD
Practice Address - Street 2:320
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-1402
Practice Address - Country:US
Practice Address - Phone:951-679-5811
Practice Address - Fax:951-679-5844
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60874207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A608740Medicaid
CAZZZ32562ZMedicare ID - Type Unspecified
CA00A608740Medicaid