Provider Demographics
NPI:1790839306
Name:NGUYET LE MD INC
Entity Type:Organization
Organization Name:NGUYET LE MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NGUYET
Authorized Official - Middle Name:BICH
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-535-5589
Mailing Address - Street 1:1771 W ROMNEYA DR STE E1
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-1817
Mailing Address - Country:US
Mailing Address - Phone:714-535-5589
Mailing Address - Fax:714-535-1026
Practice Address - Street 1:1771 W ROMNEYA DR STE E1
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1817
Practice Address - Country:US
Practice Address - Phone:714-535-5589
Practice Address - Fax:714-535-1026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2022-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81603207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG81603Medicare ID - Type UnspecifiedMEDICARE PROVIDER #