Provider Demographics
NPI:1790197085
Name:TOM L. LE, M.D., INC.
Entity Type:Organization
Organization Name:TOM L. LE, M.D., INC.
Other - Org Name:COASTLINE URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:LONG
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-710-3030
Mailing Address - Street 1:1421 W MACARTHUR BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-7318
Mailing Address - Country:US
Mailing Address - Phone:714-710-3030
Mailing Address - Fax:714-668-9596
Practice Address - Street 1:1421 W MACARTHUR BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-7318
Practice Address - Country:US
Practice Address - Phone:714-710-3030
Practice Address - Fax:714-668-9596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-21
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QP2300X, 261QU0200X, 261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1669547006OtherNPI 1
136280Medicare UPIN