Provider Demographics
NPI:1023456092
Name:KANG LE LLC
Entity type:Organization
Organization Name:KANG LE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LIXIN
Authorized Official - Middle Name:
Authorized Official - Last Name:QIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, LAC
Authorized Official - Phone:612-208-3848
Mailing Address - Street 1:17814 STEADING RD
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55347-2779
Mailing Address - Country:US
Mailing Address - Phone:612-384-5953
Mailing Address - Fax:
Practice Address - Street 1:5593 W 78TH ST
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-2701
Practice Address - Country:US
Practice Address - Phone:612-208-3848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KANG LE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-11
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1064338261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care