Provider Demographics
NPI:1841374410
Name:LE, CAC THANH (MD)
Entity type:Individual
Prefix:
First Name:CAC
Middle Name:THANH
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 1:851 MANHATTAN BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058
Mailing Address - Country:US
Mailing Address - Phone:504-368-6686
Mailing Address - Fax:
Practice Address - Street 1:851 MANHATTAN BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058
Practice Address - Country:US
Practice Address - Phone:504-368-4392
Practice Address - Fax:504-368-4396
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07096R208000000X
CAA44730208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1366277Medicaid
LA1366277Medicaid
LA52926Medicare ID - Type Unspecified