Provider Demographics
NPI:1881714756
Name:LE, HANG TM (BS)
Entity type:Individual
Prefix:MS
First Name:HANG
Middle Name:TM
Last Name:LE
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21722 SHASTA LAKE RD
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-2530
Mailing Address - Country:US
Mailing Address - Phone:949-472-8114
Mailing Address - Fax:
Practice Address - Street 1:4520 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-1133
Practice Address - Country:US
Practice Address - Phone:714-523-2960
Practice Address - Fax:714-994-2923
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 46830183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA428710Medicaid
CAPHA428710Medicaid