Healthcare Provider Details

I. General information

NPI: 1568111011
Provider Name (Legal Business Name): TIMOTHY QUOC KHOA LE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 TIMBERLACHEN CIR STE 201
LAKE MARY FL
32746-6124
US

IV. Provider business mailing address

101 TIMBERLACHEN CIR STE 201
LAKE MARY FL
32746-6124
US

V. Phone/Fax

Practice location:
  • Phone: 407-995-6499
  • Fax: 407-544-4530
Mailing address:
  • Phone: 407-995-6499
  • Fax: 407-544-4530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME167437
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: