Provider Demographics
NPI:1356520241
Name:DUNG Q LE MD A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:DUNG Q LE MD A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DUNG
Authorized Official - Middle Name:Q
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-836-3937
Mailing Address - Street 1:36921 COOK ST STE 103
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-6070
Mailing Address - Country:US
Mailing Address - Phone:760-836-3937
Mailing Address - Fax:760-836-1151
Practice Address - Street 1:36921 COOK ST
Practice Address - Street 2:SUITE 103
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-6070
Practice Address - Country:US
Practice Address - Phone:760-836-3937
Practice Address - Fax:760-836-1151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79927207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH69422Medicare UPIN