Provider Demographics
NPI:1487742961
Name:LE, PETER TRUNG-THUY (PA-C)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:TRUNG-THUY
Last Name:LE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23521 PASEO DE VALENCIA
Mailing Address - Street 2:SUITE 311
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3144
Mailing Address - Country:US
Mailing Address - Phone:949-305-2660
Mailing Address - Fax:949-305-2036
Practice Address - Street 1:23521 PASEO DE VALENCIA
Practice Address - Street 2:SUITE 311
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3144
Practice Address - Country:US
Practice Address - Phone:949-305-2660
Practice Address - Fax:949-305-2036
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 16663363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADP460ZMedicare PIN