Provider Demographics
NPI:1750607644
Name:LE, NAM QUOC (DO)
Entity type:Individual
Prefix:
First Name:NAM
Middle Name:QUOC
Last Name:LE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14772 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:MIDWAY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92655-1364
Mailing Address - Country:US
Mailing Address - Phone:909-838-0679
Mailing Address - Fax:
Practice Address - Street 1:14772 WILSON ST
Practice Address - Street 2:
Practice Address - City:MIDWAY CITY
Practice Address - State:CA
Practice Address - Zip Code:92655-1364
Practice Address - Country:US
Practice Address - Phone:909-838-0679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-16
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA20A12155207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program