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Individual
PHU LE
Active
Individual
PHU LE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
95030722
CA
Other
Enumeration date
01/14/2025
Last updated
09/21/2026
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