Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 20A16886 | CA |
NPI | 1053845974 |
---|---|
Provider Name | Andrew Nguyen Le |
First Address | Huntington Beach, CA 92647-6860 |
Second Address | Huntington Beach, CA 92647-6860 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2017 |
Last Update Date | 30/06/2021 |