Provider Demographics
NPI:1932424066
Name:LE, PHUNG NGOC (DO)
Entity type:Individual
Prefix:DR
First Name:PHUNG
Middle Name:NGOC
Last Name:LE
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Gender:M
Credentials:DO
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Mailing Address - Street 1:PO BOX 10880
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86304-0880
Mailing Address - Country:US
Mailing Address - Phone:602-406-4786
Mailing Address - Fax:916-636-4358
Practice Address - Street 1:1001 WILLOW CREEK RD STE 1200
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1614
Practice Address - Country:US
Practice Address - Phone:928-458-2850
Practice Address - Fax:928-458-2848
Is Sole Proprietor?:No
Enumeration Date:2010-03-31
Last Update Date:2025-04-10
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Provider Licenses
StateLicense IDTaxonomies
AZ19324240662086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ286413Medicaid