Basic Information
| Provider Information | |||||||||
| NPI: | 1376500215 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LE | ||||||||
| FirstName: | KHOA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 360 LINDEN OAKS STE 300 | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146252814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5853838830 | ||||||||
| FaxNumber: | 5853838901 | ||||||||
| Practice Location | |||||||||
| Address1: | 360 LINDEN OAKS STE 300 | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146252814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5853838830 | ||||||||
| FaxNumber: | 5853838901 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2006 | ||||||||
| LastUpdateDate: | 10/09/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 300900 | NY | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 200122010A | 05 | OK | MEDICAID | 0K38076101 | 01 | OK | BLUE CROSS BLUE SHIELD | OTHER |