Provider Demographics
NPI:1134366933
Name:LE, VAN (LAC,)
Entity type:Individual
Prefix:
First Name:VAN
Middle Name:
Last Name:LE
Suffix:
Gender:M
Credentials:LAC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:16171 BROOKHURST ST
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-1550
Mailing Address - Country:US
Mailing Address - Phone:714-737-1987
Mailing Address - Fax:714-531-8034
Practice Address - Street 1:16171 BROOKHURST ST
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-1550
Practice Address - Country:US
Practice Address - Phone:714-737-1987
Practice Address - Fax:714-531-8034
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 3379171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist