Healthcare Provider Details

I. General information

NPI: 1003372616
Provider Name (Legal Business Name): KEVEN LE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2019
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 S AMPHLETT BLVD STE 200
SAN MATEO CA
94402-2717
US

IV. Provider business mailing address

1200 CONCORD AVE STE 100
CONCORD CA
94520-4969
US

V. Phone/Fax

Practice location:
  • Phone: 650-507-3193
  • Fax:
Mailing address:
  • Phone: 510-268-8120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-DEROMN
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: