Provider Demographics
NPI:1073879011
Name:LE, KHANG DUC (MD)
Entity Type:Individual
Prefix:MR
First Name:KHANG
Middle Name:DUC
Last Name:LE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:802 N RIVERSIDE RD STE G50
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64507-2510
Mailing Address - Country:US
Mailing Address - Phone:816-671-4888
Mailing Address - Fax:816-671-4890
Practice Address - Street 1:802 N RIVERSIDE RD STE G50
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64507-2510
Practice Address - Country:US
Practice Address - Phone:816-671-4888
Practice Address - Fax:816-671-4890
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
MO2012016481208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program