Provider Demographics
NPI:1386282010
Name:LE, VY TUONG
Entity type:Individual
Prefix:
First Name:VY
Middle Name:TUONG
Last Name:LE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 PATRICIA LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11720-1246
Mailing Address - Country:US
Mailing Address - Phone:858-859-5678
Mailing Address - Fax:
Practice Address - Street 1:23141 MOULTON PKWY STE 210
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1204
Practice Address - Country:US
Practice Address - Phone:858-859-5678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-12
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA1087251223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDental Anesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program