Provider Demographics
NPI:1639518475
Name:LE, LIEM QUANG (LAC, DIPLO OM)
Entity Type:Individual
Prefix:MR
First Name:LIEM
Middle Name:QUANG
Last Name:LE
Suffix:
Gender:M
Credentials:LAC, DIPLO OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 EAST JACKSON STREET, #224
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602
Mailing Address - Country:US
Mailing Address - Phone:760-710-7836
Mailing Address - Fax:760-230-8747
Practice Address - Street 1:503 EAST JACKSON STREET, #224
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602
Practice Address - Country:US
Practice Address - Phone:760-710-7836
Practice Address - Fax:760-230-8747
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-14
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15530171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist