Provider Demographics
NPI:1942290762
Name:LE, SON HONG (MD)
Entity Type:Individual
Prefix:DR
First Name:SON
Middle Name:HONG
Last Name:LE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9143 VALLEY BLVD STE 101A
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-1993
Mailing Address - Country:US
Mailing Address - Phone:626-573-3545
Mailing Address - Fax:626-573-4837
Practice Address - Street 1:9143 VALLEY BLVD 101A
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-1993
Practice Address - Country:US
Practice Address - Phone:626-573-3545
Practice Address - Fax:626-573-4837
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42423207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA424230Medicaid
CABL0476766OtherDEA
CAA424230Medicaid