Provider Demographics
NPI:1558446005
Name:LE, THANH THE (ALC)
Entity Type:Individual
Prefix:
First Name:THANH
Middle Name:THE
Last Name:LE
Suffix:
Gender:M
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11062 BARCLAY DR.
Mailing Address - Street 2:APT. # 1
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92841
Mailing Address - Country:US
Mailing Address - Phone:714-363-6238
Mailing Address - Fax:
Practice Address - Street 1:12112 BROOKHURST ST.
Practice Address - Street 2:SUITE 6
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840
Practice Address - Country:US
Practice Address - Phone:714-539-0064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 10711171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist