Provider Demographics
NPI:1568493062
Name:LE, SON DIEP (MD)
Entity Type:Individual
Prefix:MR
First Name:SON
Middle Name:DIEP
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 1:5003 CROSSINGS CIRCLE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MT. JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-8568
Mailing Address - Country:US
Mailing Address - Phone:615-872-9966
Mailing Address - Fax:615-564-9300
Practice Address - Street 1:5003 CROSSINGS CIRCLE
Practice Address - Street 2:SUITE 200
Practice Address - City:MT. JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-8568
Practice Address - Country:US
Practice Address - Phone:615-872-9966
Practice Address - Fax:615-564-9300
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD35117208100000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2340061OtherUNITED HEALTH CARE
TN3377082Medicaid
TN4038594OtherBCBS OF TN
TN1264959OtherCIGNA
TN3377082Medicaid
TN4038594OtherBCBS OF TN