Provider Demographics
NPI:1982055521
Name:LE, KHAC (MD)
Entity Type:Individual
Prefix:
First Name:KHAC
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 1:1815 S KENT DES MOINES RD
Mailing Address - Street 2:APT A1
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-2406
Mailing Address - Country:US
Mailing Address - Phone:404-861-9882
Mailing Address - Fax:
Practice Address - Street 1:16315 NE 87TH ST STE B6
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3537
Practice Address - Country:US
Practice Address - Phone:425-882-1697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-24
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI72098-20207Q00000X
MI4301110252207Q00000X
ORMD198278207Q00000X
WAMD61056226207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine