MEDICARE: DR. KHOA DINH LE D.O.

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	207R00000X	Internal Medicine Physician	20A8968	CA
2	207R00000X	Internal Medicine Physician	1204	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922161736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KHOA DINH LE D.O.

Provider Business Mailing Address
First Line	:	PO BOX 30102
Second Line	:	DEPT #318
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84130-0102
Country	:	US
Telephone Number	:	702-372-6575
Fax Number	:

Provider Business Practice Location Address
First Line	:	7575 W WASHINGTON AVE STE127
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-4336
Country	:	US
Telephone Number	:	702-450-1717
Fax Number	:	702-947-6740

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

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	06/23/2023

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