Provider Demographics
NPI:1679358774
Name:LE, HIEU KHAC
Entity type:Individual
Prefix:
First Name:HIEU
Middle Name:KHAC
Last Name:LE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25557 CRESTFIELD DR
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94552-5541
Mailing Address - Country:US
Mailing Address - Phone:510-876-1305
Mailing Address - Fax:
Practice Address - Street 1:7601 STONERIDGE DR
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-4501
Practice Address - Country:US
Practice Address - Phone:925-847-5568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH49575183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist