MEDICARE: KENNY VAN LE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	0101279175	VA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207L00000X	Anesthesiology Physician	0101279175	VA

General Provider Information

NPI Number	:	1003351842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNY VAN LE MD

Provider Business Mailing Address
First Line	:	9040 JACKSON AVE
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98431-0001
Country	:	US
Telephone Number	:	253-968-1110
Fax Number	:

Provider Business Practice Location Address
First Line	:	9040 JACKSON AVE
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98431-6307
Country	:	US
Telephone Number	:	253-968-1110
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2017
Last Update Date	:	07/15/2025

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