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Individual

ANDY PHUOC QUANG LE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
17100 EUCLID ST, FOUNTAIN VALLEY, CA 92708-4004
(714) 966-7200
Mailing address
210 N TUSTIN AVE, SANTA ANA, CA 92705-3807
(714) 734-7101
(714) 647-1245

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
A78649
CA
207LP2900X
Pain Medicine (Anesthesiology) Physician
A78649
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00A786490
BLUE SHIELD
05
00A786490
CA
01
P00140823
RAILROAD MEDICARE
Enumeration date
12/14/2005
Last updated
02/04/2008
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