Provider Demographics
NPI:1265506794
Name:NGUYEN, HUONG THI LE (MD)
Entity type:Individual
Prefix:
First Name:HUONG
Middle Name:THI LE
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4444 EL CAJON BLVD
Mailing Address - Street 2:SUITE #6
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-4312
Mailing Address - Country:US
Mailing Address - Phone:619-285-1522
Mailing Address - Fax:619-285-0714
Practice Address - Street 1:4444 EL CAJON BLVD
Practice Address - Street 2:SUITE #6
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-4312
Practice Address - Country:US
Practice Address - Phone:619-285-1522
Practice Address - Fax:619-285-0714
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34653207Q00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA34653Medicaid
CAA34653Medicare PIN