NPIMap

Individual provider Active NPI

Caroline Marie Thuy Nhu Dong Le, PA-C

  • Physician Assistant
  • Pomona, CA
National Provider Identifier
1174126080
Registry record updated Apr 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
255 E Bonita Ave BLDG 9
Pomona, CA 91767-1923
Phone
(909) 450-0369
Fax
(909) 450-0366
NPI assigned
Nov 21, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 59469 CA
Surgical Physician Assistant 363AS0400X 59469 CA
Physician Assistant 363A00000X CA Primary

Addresses

Primary practice location

255 E Bonita Ave BLDG 9
Pomona, CA 91767-1923

Mailing address

255 E Bonita Ave BLDG 9
Pomona, CA 91767-1923
Phone (909) 450-0369

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240328001310 CA Practitioner - Physician Assistant 8224475066 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1115 S Sunset Ave
West Covina, CA 91790-3940
Phone (626) 962-4011

1798 N Garey Ave
Pomona, CA 91767-2918
Phone (909) 865-9500

255 E Bonita Ave
Pomona, CA 91767-1923
Phone (909) 593-3550

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
59469CAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Casa Colina Hospital and Centers for Healthcare Current Accepting new patients

Locations

255 E Bonita Ave
Bldg 9
Pomona, CA 91767
Phone (909) 450-0369

Interoperability endpoints

  • Direct secure messaging: casacolina@direct.casacolina.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1605916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745193600000",
    "number": "1174126080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 E BONITA AVE BLDG 9",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917671923",
            "telephone_number": "909-450-0369",
            "fax_number": "909-450-0366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 E BONITA AVE BLDG 9",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917671923",
            "telephone_number": "909-450-0369",
            "fax_number": "909-450-0366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LE",
        "first_name": "CAROLINE",
        "middle_name": "MARIE THUY NHU DONG",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-21",
        "last_updated": "2025-04-21",
        "certification_date": "2025-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "59469",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CA",
            "license": "59469",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pomona, CA

Sources for this page

Verify at the official NPI Registry.