Provider Demographics
NPI:1376500215
Name:LE, KHOA (MD)
Entity Type:Individual
Prefix:DR
First Name:KHOA
Middle Name:
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 1:360 LINDEN OAKS STE 300
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-2814
Mailing Address - Country:US
Mailing Address - Phone:585-383-8830
Mailing Address - Fax:585-383-8901
Practice Address - Street 1:360 LINDEN OAKS STE 300
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-2814
Practice Address - Country:US
Practice Address - Phone:585-383-8830
Practice Address - Fax:585-383-8901
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY300900208600000X
TXM18712086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200122010AMedicaid
OK0K38076101OtherBLUE CROSS BLUE SHIELD
OK200122010AMedicaid
OKOK402843Medicare PIN
TXI41669Medicare UPIN