Carol Kim Le, DO

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

17396 Issued in FL

Practice address

3702 Washington St Ste 103
Hollywood, FL 33021-8283

Phone

(954) 507-6636

NPI assigned

Sep 3, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Broward Medical Associates of South Florida,Inc

  • General Practice Physician
  • Plantation, FL
  • NPI 1568619880
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1567468800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629417600000",
    "number": "1689222663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3702 WASHINGTON ST STE 103",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330218283",
            "telephone_number": "954-507-6636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3702 WASHINGTON ST STE 103",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330218283",
            "telephone_number": "954-507-6636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LE",
        "first_name": "CAROL",
        "middle_name": "KIM",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-09-03",
        "last_updated": "2021-08-20",
        "certification_date": "2021-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "FL",
            "license": "17396",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NY",
            "license": "300511",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Austin",
            "affiliation": "N",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Austin",
            "address_1": "502 Wilmes Dr",
            "city": "Austin",
            "state": "TX",
            "country_code": "US",
            "postal_code": "787524139",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Naw Tawng Lazum
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• Le Radiant Recovery and Wellness LLC
• Le Radiant Recovery and Wellness LLC
• Nga Le, CAA
• Raicheton Chevette Le, NNP-BC
• Joy Leacock-Jarrett, PT
• Robin Leader-Landau, DO
• Shirley Leader, LMHC

• Surgery Physician in Hollywood, FL
• Providers in Hollywood, FL by specialty
• Surgery Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.