Provider Demographics
NPI:1386984045
Name:LE, THUYTIEN (MD)
Entity type:Individual
Prefix:
First Name:THUYTIEN
Middle Name:
Last Name:LE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1513 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:MO
Mailing Address - Zip Code:64030-2538
Mailing Address - Country:US
Mailing Address - Phone:816-731-1890
Mailing Address - Fax:833-996-1159
Practice Address - Street 1:1513 MAIN ST
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:MO
Practice Address - Zip Code:64030-2538
Practice Address - Country:US
Practice Address - Phone:816-731-1890
Practice Address - Fax:833-996-1159
Is Sole Proprietor?:No
Enumeration Date:2013-02-18
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-75899363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS033D00126Medicare PIN