1679750996 NPI number — KHOA D LE

Table of content: MS. MIA Y LEVY RDN (NPI 1720632565)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679750996 NPI number — KHOA D LE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KHOA D LE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679750996
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9465 WAKASHAN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89149-0502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-545-5612
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2031 MCDANIEL ST
Provider Second Line Business Practice Location Address:
SUITE # 120
Provider Business Practice Location Address City Name:
N LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89030-6303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-868-7777
Provider Business Practice Location Address Fax Number:
702-260-0333
Provider Enumeration Date:
01/29/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LE
Authorized Official First Name:
KHOA
Authorized Official Middle Name:
Authorized Official Title or Position:
SOLE PROPRIETOR
Authorized Official Telephone Number:
702-545-5612

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  1024 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)