Provider Demographics
NPI:1316992936
Name:LE, PHI-NGA MINH (MD)
Entity type:Individual
Prefix:
First Name:PHI-NGA
Middle Name:MINH
Last Name:LE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PHI
Other - Middle Name:
Other - Last Name:LE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:157 S LINCOLN AVE
Mailing Address - Street 2:#D
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60505-4264
Mailing Address - Country:US
Mailing Address - Phone:630-859-0015
Mailing Address - Fax:630-859-0021
Practice Address - Street 1:157 S LINCOLN AVE
Practice Address - Street 2:#D
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60505-4264
Practice Address - Country:US
Practice Address - Phone:630-859-0015
Practice Address - Fax:630-859-0021
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036115479208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
G57293Medicare UPIN