Provider Demographics
NPI:1659446136
Name:NGUYEN-LE, CHRISTINE ANH MAI (OD)
Entity Type:Individual
Prefix:MISS
First Name:CHRISTINE
Middle Name:ANH MAI
Last Name:NGUYEN-LE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15382 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-6341
Mailing Address - Country:US
Mailing Address - Phone:714-548-1481
Mailing Address - Fax:
Practice Address - Street 1:4200 CHINO HILLS PKWY
Practice Address - Street 2:STE 810
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-3785
Practice Address - Country:US
Practice Address - Phone:909-479-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2020-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11519152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0115190Medicaid
CASD0115190Medicaid