Provider Demographics
NPI:1104615384
Name:LE, JUSTIN MINH-TIEN
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:MINH-TIEN
Last Name:LE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7901 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-8509
Mailing Address - Country:US
Mailing Address - Phone:520-694-8888
Mailing Address - Fax:520-694-8466
Practice Address - Street 1:7901 E 22ND ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-8509
Practice Address - Country:US
Practice Address - Phone:520-694-8888
Practice Address - Fax:520-694-8466
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR81870207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine