Provider Demographics
NPI:1578906988
Name:LE, THAO PHUONG H (MD)
Entity Type:Individual
Prefix:DR
First Name:THAO PHUONG
Middle Name:H
Last Name:LE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 MADISON ST STE 600
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-1340
Mailing Address - Country:US
Mailing Address - Phone:206-212-2020
Mailing Address - Fax:206-215-2022
Practice Address - Street 1:1101 MADISON ST STE 600
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-1340
Practice Address - Country:US
Practice Address - Phone:206-212-2020
Practice Address - Fax:206-215-2022
Is Sole Proprietor?:No
Enumeration Date:2013-04-16
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301112323207W00000X
390200000X
WAMD60836561207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD60836561OtherSTATE LICENSE
WAML60363168OtherSTATE LICENSE
WAML60363168OtherSTATE LINCENSE