Healthcare Provider Details

I. General information

NPI: 1134848963
Provider Name (Legal Business Name): KEVIN LE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2022
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5444 FAIRWAY DR
SAN JOSE CA
95127-1609
US

IV. Provider business mailing address

5444 FAIRWAY DR
SAN JOSE CA
95127-1609
US

V. Phone/Fax

Practice location:
  • Phone: 408-417-0131
  • Fax:
Mailing address:
  • Phone: 408-417-0131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: