Provider Demographics
NPI:1386729853
Name:LE, MIKE TIEN MINH (DC)
Entity type:Individual
Prefix:DR
First Name:MIKE TIEN
Middle Name:MINH
Last Name:LE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1637 IRVING ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-1813
Mailing Address - Country:US
Mailing Address - Phone:415-682-7798
Mailing Address - Fax:415-682-7876
Practice Address - Street 1:1637 IRVING ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-1813
Practice Address - Country:US
Practice Address - Phone:415-682-7798
Practice Address - Fax:415-682-7876
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-27798111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC27798OtherCA LICENSE NUMBER
1154491652OtherNPPES
CADC0277980Medicaid
CADC0277980Medicare ID - Type Unspecified