Provider Demographics
NPI:1821027418
Name:LE, BAO QUOC (MD)
Entity Type:Individual
Prefix:MR
First Name:BAO
Middle Name:QUOC
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 1:2944 E ANAHEIM ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-3726
Mailing Address - Country:US
Mailing Address - Phone:562-599-5777
Mailing Address - Fax:562-433-2886
Practice Address - Street 1:2944 E ANAHEIM ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-3726
Practice Address - Country:US
Practice Address - Phone:562-599-5777
Practice Address - Fax:562-433-2886
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34114208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A341140Medicaid
A34114Medicare ID - Type Unspecified
CA00A341140Medicaid