Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 32464 | AZ |
NPI | 1003866526 |
---|---|
Provider Name | Dr. Khoa Dang Le |
First Address | Gilbert, AZ 85299-1847 |
Second Address | Chandler, AZ 85224-6282 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 01/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BL7644809 | DEA (01) | |
I11358 | (02) | |
P00392051 | MEDICARE RR (01) | AZ |
P01458789 | MEDICARE RR (01) | AZ |