Basic Information
| Provider Information | |||||||||
| NPI: | 1992772990 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LE | ||||||||
| FirstName: | HAIYEN | ||||||||
| MiddleName: | T. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11840 FM 1960 RD W | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770653840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8329127044 | ||||||||
| FaxNumber: | 8329127033 | ||||||||
| Practice Location | |||||||||
| Address1: | 11840 FM 1960 RD W | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770653840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8329127044 | ||||||||
| FaxNumber: | 8329127033 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2006 | ||||||||
| LastUpdateDate: | 10/16/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | K5330 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 160185803 | 05 | TX | MEDICAID | 760608874 | 01 | TX | TAX ID# | OTHER | 160185801 | 05 | TX | MEDICAID |