Provider Demographics
NPI:1629261805
Name:LE, TANG DINH (DO)
Entity Type:Individual
Prefix:DR
First Name:TANG
Middle Name:DINH
Last Name:LE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2704 N GALLOWAY AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-6379
Mailing Address - Country:US
Mailing Address - Phone:972-288-3376
Mailing Address - Fax:972-288-3377
Practice Address - Street 1:2704 N GALLOWAY AVE STE 101
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6379
Practice Address - Country:US
Practice Address - Phone:972-288-3376
Practice Address - Fax:972-288-3377
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3134207NS0135X, 207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX340046701Medicaid
TX340046701Medicaid