Provider Demographics
NPI:1730155342
Name:LE, LONG T (DC)
Entity type:Individual
Prefix:DR
First Name:LONG
Middle Name:T
Last Name:LE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3580 CALIFORNIA ST
Mailing Address - Street 2:SUITE # 102
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1725
Mailing Address - Country:US
Mailing Address - Phone:415-921-6200
Mailing Address - Fax:415-921-6206
Practice Address - Street 1:3580 CALIFORNIA ST
Practice Address - Street 2:SUITE # 102
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1725
Practice Address - Country:US
Practice Address - Phone:415-921-6200
Practice Address - Fax:415-921-6206
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27342111NS0005X, 111NX0100X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111NS0005XChiropractic ProvidersChiropractorSports Physician
Not Answered111NX0100XChiropractic ProvidersChiropractorOccupational Health
Not Answered111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC27342Medicare ID - Type Unspecified