Healthcare Provider Details

I. General information

NPI: 1205533171
Provider Name (Legal Business Name): HUONG LE KEIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2023
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3919 MACDONALD AVE
RICHMOND CA
94805-2229
US

IV. Provider business mailing address

780 TAYLOR AVE APT A
ALAMEDA CA
94501-6710
US

V. Phone/Fax

Practice location:
  • Phone: 510-599-1689
  • Fax:
Mailing address:
  • Phone: 510-599-1689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: