Provider Demographics
NPI:1699770370
Name:LE, TAM HUU (MD)
Entity type:Individual
Prefix:
First Name:TAM
Middle Name:HUU
Last Name:LE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:18111 BROOKHURST ST
Mailing Address - Street 2:2600
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-6728
Mailing Address - Country:US
Mailing Address - Phone:714-861-4560
Mailing Address - Fax:714-861-4566
Practice Address - Street 1:18225 BROOKHURST ST STE 1
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-6719
Practice Address - Country:US
Practice Address - Phone:714-861-4560
Practice Address - Fax:714-861-4566
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2022-06-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG59425208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC70827Medicare UPIN
CAW18045Medicare ID - Type Unspecified