Basic Information
| Provider Information | |||||||||
| NPI: | 1053906578 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KY LE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 95-1092 PAEMOKU PL | ||||||||
| Address2: | |||||||||
| City: | MILILANI | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967896524 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 98-1079 MOANALUA RD | ||||||||
| Address2: | |||||||||
| City: | AIEA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967014713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085360300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2021 | ||||||||
| LastUpdateDate: | 04/21/2021 | ||||||||
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| AuthorizedOfficialLastName: | LE | ||||||||
| AuthorizedOfficialFirstName: | KY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8083458996 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 04/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.