MEDICARE: KIM LIEN LE

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	133N00000X	Nutritionist

General Provider Information

NPI Number	:	1669188959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM LIEN LE

Provider Business Mailing Address
First Line	:	1901 ONION CREEK PKWY APT 9107
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78748-1975
Country	:	US
Telephone Number	:	630-945-0885
Fax Number	:

Provider Business Practice Location Address
First Line	:	1901 ONION CREEK PKWY APT 9107
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78748-1975
Country	:	US
Telephone Number	:	630-945-0885
Fax Number	:

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

Provider Enumeration Date	:	01/30/2023
Last Update Date	:	01/30/2023

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Directions to “ KIM LIEN LE ” Practice Location

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