MEDICARE: NGHI-BINH HA LE DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	SC007209	PA
2	213ES0103X	Foot & Ankle Surgery Podiatrist	2105	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SC007209	OTHER	PA	LICENSE

General Provider Information

NPI Number	:	1053082644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NGHI-BINH HA LE DPM

Provider Business Mailing Address
First Line	:	4335 S GRAND CANYON DR UNIT 183
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-7187
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4335 S GRAND CANYON DR UNIT 183
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-7187
Country	:	US
Telephone Number	:	610-428-2467
Fax Number	:

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

Provider Enumeration Date	:	09/23/2021
Last Update Date	:	04/15/2025

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