Provider Demographics
NPI:1861441552
Name:LE, SON THANH (MD)
Entity Type:Individual
Prefix:DR
First Name:SON
Middle Name:THANH
Last Name:LE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8887 WESTMINSTER AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-2608
Mailing Address - Country:US
Mailing Address - Phone:714-698-3880
Mailing Address - Fax:714-698-3886
Practice Address - Street 1:8887 WESTMINSTER AVE
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-2608
Practice Address - Country:US
Practice Address - Phone:714-698-3880
Practice Address - Fax:714-698-3886
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63381207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A633810Medicaid
CAH12416Medicare UPIN
CAA63381Medicare ID - Type Unspecified