Provider Demographics
NPI:1962442103
Name:LE, THINH TRUNG (DPM)
Entity Type:Individual
Prefix:DR
First Name:THINH
Middle Name:TRUNG
Last Name:LE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:903 WOODSPRING PL
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-4385
Mailing Address - Country:US
Mailing Address - Phone:909-860-8421
Mailing Address - Fax:909-860-8421
Practice Address - Street 1:127 S BRAND BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-1342
Practice Address - Country:US
Practice Address - Phone:818-241-9100
Practice Address - Fax:818-551-9634
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAE4208213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU76126Medicare UPIN
CAWE4208BMedicare PIN
CADE175AMedicare PIN
CAWE4208AMedicare PIN