Provider Demographics
NPI:1770544652
Name:TAM H. LE, MD INC.
Entity type:Organization
Organization Name:TAM H. LE, MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:TAM
Authorized Official - Middle Name:HUU
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-861-4560
Mailing Address - Street 1:18111 BROOKHURST ST
Mailing Address - Street 2:2600
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-6728
Mailing Address - Country:US
Mailing Address - Phone:714-861-4560
Mailing Address - Fax:714-861-4566
Practice Address - Street 1:18225 BROOKHURST ST STE 1
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-6719
Practice Address - Country:US
Practice Address - Phone:714-861-4560
Practice Address - Fax:714-861-4566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-30
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG59425174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC70827Medicare UPIN
CAW18045Medicare PIN