Provider Demographics
NPI:1780217463
Name:LE, KIM N (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:N
Last Name:LE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 LAKE EAST DR APT 2082
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-2216
Mailing Address - Country:US
Mailing Address - Phone:704-941-7187
Mailing Address - Fax:
Practice Address - Street 1:500 E WINDMILL LN STE 155
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-1844
Practice Address - Country:US
Practice Address - Phone:702-800-2723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-20
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7550207Q00000X
NVPA25432083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine