Provider Demographics
NPI:1669792701
Name:LE, THUY DUONG THI (DPM)
Entity type:Individual
Prefix:
First Name:THUY DUONG
Middle Name:THI
Last Name:LE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:368 LEORA PARK ST
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-1315
Mailing Address - Country:US
Mailing Address - Phone:206-375-8681
Mailing Address - Fax:866-411-5120
Practice Address - Street 1:1 BOONE ROAD
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312
Practice Address - Country:US
Practice Address - Phone:206-375-8681
Practice Address - Fax:866-411-5120
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-10
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00303100213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery