Provider Demographics
NPI:1952532715
Name:LE, TIMA TINH (DO)
Entity Type:Individual
Prefix:
First Name:TIMA
Middle Name:TINH
Last Name:LE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 N 24TH ST STE 210
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-6536
Mailing Address - Country:US
Mailing Address - Phone:602-840-0681
Mailing Address - Fax:602-957-1570
Practice Address - Street 1:3700 N 24TH ST
Practice Address - Street 2:SUITE 210
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-6534
Practice Address - Country:US
Practice Address - Phone:602-840-0681
Practice Address - Fax:602-957-1570
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ006050208100000X, 2081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z161100OtherPTAN