Provider Demographics
NPI:1053315937
Name:LE, JENNY (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNY
Middle Name:
Last Name:LE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:TSAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2611 KELLEY POINTE PKWY
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-2994
Mailing Address - Country:US
Mailing Address - Phone:405-359-0919
Mailing Address - Fax:
Practice Address - Street 1:2611 KELLEY POINTE PKWY
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-2994
Practice Address - Country:US
Practice Address - Phone:405-359-0919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK22323207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1122323Medicaid
TX8EA261Medicare ID - Type UnspecifiedTRAILBLAZER HEALTH
OK1122323Medicaid