Individual
DR. THIENQUANG DAT LE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4001 FAIR RIDGE DR, SUITE 206, FAIRFAX, VA 22033-2917
(703) 716-5404
(703) 716-5410
Mailing address
4001 FAIR RIDGE DR, SUITE 206, FAIRFAX, VA 22033-2917
(703) 716-5404
(703) 716-5410
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101840408
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005828031
—
VA
01
—
208794
ANTHEM BCBS
VA
01
—
2198660
AETNA-HMO
—
01
—
27-1285868
UNITED HEALTH CARE
—
Enumeration date
10/03/2006
Last updated
12/08/2009
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