Provider Demographics
NPI:1528243359
Name:LE, TUAN DAI (MD)
Entity type:Individual
Prefix:DR
First Name:TUAN
Middle Name:DAI
Last Name:LE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1151 E HOLT AVE
Mailing Address - Street 2:SUITE Q
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-5813
Mailing Address - Country:US
Mailing Address - Phone:909-620-8436
Mailing Address - Fax:909-868-5134
Practice Address - Street 1:1151 E HOLT AVE
Practice Address - Street 2:SUITE Q
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-5813
Practice Address - Country:US
Practice Address - Phone:909-620-8436
Practice Address - Fax:909-868-5134
Is Sole Proprietor?:No
Enumeration Date:2007-12-28
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA60032207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A600321Medicaid
CAA60032AMedicare PIN
CA00A600321Medicaid