Organization Active NPI

Tuan Dai Le, M.D, a Professional Corporation

  • Family Medicine Physician
  • Pomona, CA
National Provider Identifier
1205017035
Registry record updated Jun 25, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A60032 Issued in CA
Legal business name
TUAN DAI LE, M.D, A PROFESSIONAL CORPORATION
Practice address
1151 E Holt Ave
Suite Q
Pomona, CA 91767-5813
Phone
(909) 620-8436
Fax
(909) 868-5134
NPI assigned
Nov 20, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2014

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

Authorized official

Name
Dr. Tuan Dai Le, MDNPI 1528243359
Title
Owner
Phone
(909) 620-8436

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X A60032 CA Primary

Addresses

Primary practice location

1151 E Holt Ave
Suite Q
Pomona, CA 91767-5813

Mailing address

1151 E Holt Ave
Suite Q
Pomona, CA 91767-5813
Phone (909) 620-8436

Other identifiers 1

IdentifierTypeStateIssuer
00A600321MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080606000681 CA Part B Supplier - Clinic/Group Practice 9638249329 Receives reassigned benefits from 1 practitioner
Practice locations: Pomona, CA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2062989Tuan Dai Le Corporation Professional1151 E Holt Ave Ste Q, Pomona, CA 91767Certificate of waiverJul 23, 2025

National Provider Directory

National Provider Directory

Locations

1151 E Holt Ave
Pomona, CA 91767

1151 E Holt Ave
Ste Q
Pomona, CA 91767
Phone (909) 620-8436

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1195516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403654400000",
    "number": "1205017035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1151 E HOLT AVE",
            "address_2": "SUITE Q",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917675813",
            "telephone_number": "909-620-8436",
            "fax_number": "909-868-5134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1151 E HOLT AVE",
            "address_2": "SUITE Q",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917675813",
            "telephone_number": "909-620-8436",
            "fax_number": "909-868-5134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TUAN DAI LE, M.D, A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-20",
        "last_updated": "2014-06-25",
        "status": "A",
        "authorized_official_last_name": "LE",
        "authorized_official_first_name": "TUAN",
        "authorized_official_middle_name": "DAI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "909-620-8436",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A60032",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A600321",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pomona, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.