Healthcare Provider Details

I. General information

NPI: 1346803236
Provider Name (Legal Business Name): REMI MINH KHANG LE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2019
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date: 12/04/2019
Reactivation Date: 04/03/2020

III. Provider practice location address

654 PHILADELPHIA AVE
SHILLINGTON PA
19607-2769
US

IV. Provider business mailing address

654 PHILADELPHIA AVE
SHILLINGTON PA
19607-2769
US

V. Phone/Fax

Practice location:
  • Phone: 610-796-9522
  • Fax:
Mailing address:
  • Phone: 610-796-9522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC007238
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36.004049
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: