Individual provider Active NPI

Lina Duyen Khanh Le, MD

  • Diagnostic Radiology Physician
  • Anaheim, CA
National Provider Identifier
1912074402
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
G72979 Issued in CA
Practice address
1111 West la Palma Ave
Anaheim, CA 92801-2804
Phone
(714) 999-6080
Fax
(714) 999-3924
NPI assigned
Nov 29, 2006
Last updated
Mar 7, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X G72979 CA Primary

Addresses

Primary practice location

1111 West la Palma Ave
Anaheim, CA 92801-2804

Mailing address

PO Box 4505
Woodland Hills, CA 91365-4505
Phone (818) 597-3800

Other identifiers 2

IdentifierTypeStateIssuer
00G729790MedicaidCA
RHL135878OtherCADEPT OF HEALTH SERVICES

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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

Enrollment IDStateProvider typePAC IDDetails
I20080522000595 CA Practitioner - Diagnostic Radiology 4183793607 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
G72979CAMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Medical Foundation CurrentSince Feb 1, 2021 Accepting new patients
Shin Imaging LLC CurrentSince Apr 17, 2017 Accepting new patients
Providence Medical Foundation Current Accepting new patients
Shin MRI LLC CurrentSince Jan 1, 2018 Accepting new patients
North Oc Imaging JV, LLC CurrentSince Oct 1, 2024 Accepting new patients
Dynamic Imaging Associates of California, Inc CurrentSince Oct 29, 2021 Accepting new patients
Shin Imaging LLC CurrentSince Jan 1, 2019 Accepting new patients
Providence Medical Foundation CurrentSince Feb 1, 2021 Accepting new patients
North Oc Imaging JV, LLC CurrentSince Oct 1, 2024 Accepting new patients

Locations

19333 Bear Valley Rd
Ste 106
Apple Valley, CA 92308
Phone (760) 240-5505

15855 Pomona Rincon Rd
Ste 101
Chino Hills, CA 91709

1125 E Spruce Ave
Ste 103
Fresno, CA 93720
Phone (553) 475-0286

13400 Jamboree Rd
Irvine, CA 92602
Phone (714) 263-9279

1165 Montgomery Dr
#1112
Santa Rosa, CA 95405
Phone (707) 546-3210

12602 Amargosa Rd
Ste F
Victorville, CA 92392
Phone (760) 261-5000

Organizations & group practices 10

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

NPI Registry JSON

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1912074402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4505",
            "city": "WOODLAND HILLS",
            "state": "CA",
            "postal_code": "913654505",
            "telephone_number": "818-597-3800",
            "fax_number": "818-879-8272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 WEST LA PALMA AVE",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928012804",
            "telephone_number": "714-999-6080",
            "fax_number": "714-999-3924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LE",
        "first_name": "LINA",
        "middle_name": "DUYEN KHANH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-29",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "G72979",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G729790",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF HEALTH SERVICES",
            "identifier": "RHL135878",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Anaheim, CA

Sources for this page

Verify at the official NPI Registry.