Provider Demographics
NPI:1659457315
Name:LE, PHUONG-THUY THI (MD)
Entity Type:Individual
Prefix:DR
First Name:PHUONG-THUY
Middle Name:THI
Last Name:LE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PHUONG-THUY
Other - Middle Name:
Other - Last Name:QUANG-DANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:200 JOSE FIGUERES AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1500
Mailing Address - Country:US
Mailing Address - Phone:408-259-6022
Mailing Address - Fax:408-259-6013
Practice Address - Street 1:200 JOSE FIGUERES AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1500
Practice Address - Country:US
Practice Address - Phone:408-259-6022
Practice Address - Fax:408-259-6013
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA0445012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9207822Medicaid
CA9207822Medicaid