Basic Information
| Provider Information | |||||||||
| NPI: | 1093209025 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LE | ||||||||
| FirstName: | STEVEN | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3900 SAN FERNANDO RD APT 2313 | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912042875 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173127420 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3033 W ORANGE AVE | ||||||||
| Address2: | |||||||||
| City: | ANAHEIM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928043156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148273000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2018 | ||||||||
| LastUpdateDate: | 11/29/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | PTL1317 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.