Healthcare Provider Details

I. General information

NPI: 1922161736
Provider Name (Legal Business Name): KHOA DINH LE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 06/23/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7575 W WASHINGTON AVE STE127
LAS VEGAS NV
89128-4336
US

IV. Provider business mailing address

PO BOX 30102 DEPT #318
SALT LAKE CITY UT
84130-0102
US

V. Phone/Fax

Practice location:
  • Phone: 702-450-1717
  • Fax: 702-947-6740
Mailing address:
  • Phone: 702-372-6575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A8968
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1204
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: