Provider Demographics
NPI:1346803236
Name:LE, REMI MINH KHANG
Entity Type:Individual
Prefix:
First Name:REMI MINH KHANG
Middle Name:
Last Name:LE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:654 PHILADELPHIA AVE
Mailing Address - Street 2:
Mailing Address - City:SHILLINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19607-2769
Mailing Address - Country:US
Mailing Address - Phone:610-796-9522
Mailing Address - Fax:
Practice Address - Street 1:654 PHILADELPHIA AVE
Practice Address - Street 2:
Practice Address - City:SHILLINGTON
Practice Address - State:PA
Practice Address - Zip Code:19607-2769
Practice Address - Country:US
Practice Address - Phone:610-796-9522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-17
Last Update Date:2024-02-28
Deactivation Date:2019-12-04
Deactivation Code:
Reactivation Date:2020-04-03
Provider Licenses
StateLicense IDTaxonomies
PASC007238213ES0103X
OH36.004049213ES0103X
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program