Provider Demographics
NPI:1972817138
Name:LE, CHINH T (FNP-C)
Entity Type:Individual
Prefix:
First Name:CHINH
Middle Name:T
Last Name:LE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9243 ALMONDWILLOW WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-5402
Mailing Address - Country:US
Mailing Address - Phone:916-428-3788
Mailing Address - Fax:916-428-0788
Practice Address - Street 1:7275 E SOUTHGATE DR
Practice Address - Street 2:204
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2628
Practice Address - Country:US
Practice Address - Phone:916-428-3788
Practice Address - Fax:916-428-0788
Is Sole Proprietor?:No
Enumeration Date:2010-07-29
Last Update Date:2022-01-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA18713363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA18713Medicaid