Provider Demographics
NPI:1710207576
Name:LE, KENNY THANG
Entity Type:Individual
Prefix:
First Name:KENNY
Middle Name:THANG
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 1:10375 RICHMOND AVE
Mailing Address - Street 2:STE. 1575
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042
Mailing Address - Country:US
Mailing Address - Phone:866-312-1177
Mailing Address - Fax:713-513-5924
Practice Address - Street 1:10375 RICHMOND AVE
Practice Address - Street 2:STE. 1575
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-4143
Practice Address - Country:US
Practice Address - Phone:866-312-1177
Practice Address - Fax:713-513-5924
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43268183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist