Provider Demographics
NPI:1760559819
Name:LE, THANG TRUNG (MD)
Entity Type:Individual
Prefix:
First Name:THANG
Middle Name:TRUNG
Last Name:LE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:548 N 13TH AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4917
Mailing Address - Country:US
Mailing Address - Phone:909-982-0099
Mailing Address - Fax:909-931-0402
Practice Address - Street 1:548 N 13TH AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4917
Practice Address - Country:US
Practice Address - Phone:909-982-0099
Practice Address - Fax:909-931-0402
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74522207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A745220Medicaid
H82917Medicare UPIN