Provider Demographics
NPI:1538479472
Name:DR DE HIEU LE A PROFESSIONAL CORP
Entity type:Organization
Organization Name:DR DE HIEU LE A PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DE
Authorized Official - Middle Name:HIEU
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL DOCTOR
Authorized Official - Phone:510-839-2758
Mailing Address - Street 1:312-13TH STREET
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3917
Mailing Address - Country:US
Mailing Address - Phone:510-839-0859
Mailing Address - Fax:
Practice Address - Street 1:312 13TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-3917
Practice Address - Country:US
Practice Address - Phone:510-839-0859
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-13
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35088207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty