Provider Demographics
NPI:1760613574
Name:LE, MAITHAO NGOC (MD)
Entity Type:Individual
Prefix:
First Name:MAITHAO
Middle Name:NGOC
Last Name:LE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:41 BENNINGTON PARKWAY
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08823
Mailing Address - Country:US
Mailing Address - Phone:732-297-1044
Mailing Address - Fax:
Practice Address - Street 1:1500 DUARTE RD
Practice Address - Street 2:DIVISION OF GENERAL AND ONCOLOGIC SURGERY
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-3012
Practice Address - Country:US
Practice Address - Phone:626-471-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-29
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA08620200208600000X
CAA1128352086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery