Provider Demographics
NPI:1497779979
Name:MINH-HOANG LE, MD LLC
Entity Type:Organization
Organization Name:MINH-HOANG LE, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MINH-HOANG
Authorized Official - Middle Name:NGUYEN
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-279-5055
Mailing Address - Street 1:1300 N 12TH ST
Mailing Address - Street 2:SUITE 312
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2848
Mailing Address - Country:US
Mailing Address - Phone:602-279-5055
Mailing Address - Fax:602-279-5155
Practice Address - Street 1:1300 N 12TH ST
Practice Address - Street 2:SUITE 312
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2848
Practice Address - Country:US
Practice Address - Phone:602-279-5055
Practice Address - Fax:602-279-5155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29099207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ109016Medicare PIN
AZH36224Medicare UPIN
AZ109015Medicare PIN