Provider Demographics
NPI:1003928623
Name:LE, QUANG KIM (MD)
Entity Type:Individual
Prefix:DR
First Name:QUANG
Middle Name:KIM
Last Name:LE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26700 BROOKPARK ROAD EXT
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-3124
Mailing Address - Country:US
Mailing Address - Phone:440-716-0800
Mailing Address - Fax:440-716-1605
Practice Address - Street 1:615 FULTON ST
Practice Address - Street 2:
Practice Address - City:PORT CLINTON
Practice Address - State:OH
Practice Address - Zip Code:43452-2001
Practice Address - Country:US
Practice Address - Phone:419-734-3131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-074958207R00000X
OH35.074958207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2190972Medicaid
OHLE4021883Medicare PIN
H16676Medicare UPIN
OHP00443873Medicare PIN
OHLE305871Medicare PIN