Provider Demographics
NPI:1215955679
Name:LE, DANH THANH (PAC)
Entity type:Individual
Prefix:
First Name:DANH
Middle Name:THANH
Last Name:LE
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 S LANCASTER RD
Mailing Address - Street 2:PMR-117
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75216-7167
Mailing Address - Country:US
Mailing Address - Phone:800-849-3597
Mailing Address - Fax:214-857-1281
Practice Address - Street 1:4500 S LANCASTER RD
Practice Address - Street 2:PMR-117
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-7167
Practice Address - Country:US
Practice Address - Phone:800-849-3597
Practice Address - Fax:214-857-1281
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04821363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181861901Medicaid
TXQ71561Medicare UPIN