Provider Demographics
NPI:1366763864
Name:LE, VAN THANH
Entity type:Individual
Prefix:
First Name:VAN
Middle Name:THANH
Last Name:LE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 AVIATION BLVD
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-2810
Mailing Address - Country:US
Mailing Address - Phone:310-376-4460
Mailing Address - Fax:310-379-2136
Practice Address - Street 1:1720 AVIATION BLVD
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-2810
Practice Address - Country:US
Practice Address - Phone:310-376-4460
Practice Address - Fax:310-379-2136
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61732183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist