Provider Demographics
NPI:1730269564
Name:LE, TRI T (PA)
Entity type:Individual
Prefix:MR
First Name:TRI
Middle Name:T
Last Name:LE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:13402 MAGNOLIA ST APT 5
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-2246
Mailing Address - Country:US
Mailing Address - Phone:714-539-9960
Mailing Address - Fax:
Practice Address - Street 1:19401 S VERMONT AVE STE L100
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-4459
Practice Address - Country:US
Practice Address - Phone:310-324-5777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA 18015363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical