Provider Demographics
NPI:1457393308
Name:LE, HIEP VAN (MD)
Entity Type:Individual
Prefix:
First Name:HIEP
Middle Name:VAN
Last Name:LE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7223 CHURCH ST
Mailing Address - Street 2:SUITE A-20
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-5869
Mailing Address - Country:US
Mailing Address - Phone:909-882-0702
Mailing Address - Fax:909-886-6704
Practice Address - Street 1:7223 CHURCH ST
Practice Address - Street 2:SUITE A-20
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-5869
Practice Address - Country:US
Practice Address - Phone:909-882-0702
Practice Address - Fax:909-886-6704
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA051678207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG13643Medicare UPIN
CA00A516780Medicare ID - Type Unspecified