Healthcare Provider Details

I. General information

NPI: 1043830193
Provider Name (Legal Business Name): JIM LE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2020
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 MCCAIN BLVD
SAN DIEGO CA
92118
US

IV. Provider business mailing address

601 MCCAIN BLVD
SAN DIEGO CA
92118
US

V. Phone/Fax

Practice location:
  • Phone: 619-545-6210
  • Fax:
Mailing address:
  • Phone: 619-545-6210
  • Fax: 619-545-0886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number2021-03058
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: