Provider Demographics
NPI:1477243327
Name:LE, VUONG BRANDON
Entity Type:Individual
Prefix:
First Name:VUONG
Middle Name:BRANDON
Last Name:LE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6234 N STATE HIGHWAY 6
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-2672
Mailing Address - Country:US
Mailing Address - Phone:254-214-6454
Mailing Address - Fax:
Practice Address - Street 1:6234 N STATE HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-2672
Practice Address - Country:US
Practice Address - Phone:254-214-6454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program