Individual provider Active NPI

Ethan Le, PA-C

  • Physician Assistant
  • Santa Ana, CA
National Provider Identifier
1891541066
Registry record updated Jan 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
714 S Harbor Blvd Ste a
Santa Ana, CA 92704-2337
Phone
(714) 714-0016
Fax
(714) 486-3744
NPI assigned
Apr 27, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

714 S Harbor Blvd Ste a
Santa Ana, CA 92704-2337

Mailing address

714 S Harbor Blvd Ste a
Santa Ana, CA 92704-2337
Phone (714) 714-0016

Other practice location 1

16038 Newhope Way
Fountain Valley, CA 92708-1704
Phone (714) 548-2955

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250512000509 CA Practitioner - Physician Assistant 0446777627 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Vu D Tran MD IncGroup PAC ID 6002146693, 3 clinicians

Practice addresses (Care Compare)

16111 Beach Blvd
Suite A1
Huntington Beach, CA 92647-3804
Phone (714) 596-0368

National Provider Directory

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

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1714176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737936000000",
    "number": "1891541066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "714 S HARBOR BLVD STE A",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927042337",
            "telephone_number": "714-714-0016",
            "fax_number": "714-486-3744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "714 S HARBOR BLVD STE A",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927042337",
            "telephone_number": "714-714-0016",
            "fax_number": "714-486-3744"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16038 Newhope Way",
            "address_purpose": "LOCATION",
            "city": "Fountain Valley",
            "state": "CA",
            "postal_code": "927081704",
            "country_code": "US",
            "telephone_number": "714-548-2955",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LE",
        "first_name": "ETHAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-04-27",
        "last_updated": "2025-01-27",
        "certification_date": "2025-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Ana, CA

Sources for this page

Verify at the official NPI Registry.