Provider Demographics
NPI:1295731412
Name:LE, DUNG S (DPM)
Entity type:Individual
Prefix:
First Name:DUNG
Middle Name:S
Last Name:LE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 WHEELING AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN DALE
Mailing Address - State:WV
Mailing Address - Zip Code:26038-1536
Mailing Address - Country:US
Mailing Address - Phone:304-233-9314
Mailing Address - Fax:304-233-0265
Practice Address - Street 1:401 WHEELING AVE
Practice Address - Street 2:
Practice Address - City:GLEN DALE
Practice Address - State:WV
Practice Address - Zip Code:26038-1536
Practice Address - Country:US
Practice Address - Phone:304-845-6645
Practice Address - Fax:304-845-6646
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV00278213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV00997755000Medicaid
OH0926912Medicaid
WV0743013Medicare PIN
U42923Medicare UPIN