Provider Demographics
NPI:1922161736
Name:LE, KHOA DINH (DO)
Entity Type:Individual
Prefix:DR
First Name:KHOA
Middle Name:DINH
Last Name:LE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30102
Mailing Address - Street 2:DEPT #318
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84130-0102
Mailing Address - Country:US
Mailing Address - Phone:702-372-6575
Mailing Address - Fax:
Practice Address - Street 1:7575 W WASHINGTON AVE STE127
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-4336
Practice Address - Country:US
Practice Address - Phone:702-450-1717
Practice Address - Fax:702-947-6740
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8968207R00000X
NV1204207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0639636Medicaid
NV100509024Medicaid
V105375Medicare UPIN
NV100509024Medicaid