Provider Demographics
NPI:1336381607
Name:LE, TAM CANH (MD)
Entity Type:Individual
Prefix:DR
First Name:TAM
Middle Name:CANH
Last Name:LE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:15521 SUNBURST LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-2942
Mailing Address - Country:US
Mailing Address - Phone:714-643-9442
Mailing Address - Fax:714-643-9441
Practice Address - Street 1:9746 WESTMINSTER AVE
Practice Address - Street 2:SUITE D3
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-2984
Practice Address - Country:US
Practice Address - Phone:714-643-9442
Practice Address - Fax:714-643-9441
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV14412207R00000X
CAA117637207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1336381607Medicaid
12410527OtherCAQH
NV1336381607Medicaid