Individual provider Active NPI

Khuyet T Le, PA

  • Physician Assistant
  • Syracuse, NY
National Provider Identifier
1982896635
Registry record updated Jun 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
011913 Issued in NY
Practice address
725 E. Adams Street
5TH FL
Syracuse, NY 13210
Phone
(315) 464-5726
Fax
(315) 464-2500
NPI assigned
Aug 16, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 011913 NY Primary

Addresses

Primary practice location

725 E. Adams Street
5TH FL
Syracuse, NY 13210

Mailing address

725 E. Adams Street
5TH FL
Syracuse, NY 13210
Phone (315) 464-5726

Other identifiers 1

IdentifierTypeStateIssuer
03123508MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090622000545 NY Practitioner - Physician Assistant 1254482888 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
011913NYMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Department of Medicine Medical Serv GRP at Suny HLTH Sci Ctr Syr in CurrentSince Aug 17, 2009 Accepting new patients

Locations

750 E Adams St
Syracuse, NY 13210
Phone (315) 464-4363

3229 E Genesee St
Syracuse, NY 13214
Phone (315) 446-7501

251 Salina Meadows Pkwy
Ste 100
Syracuse, NY 13212
Phone (315) 464-2000

725 E Adams St
Fl 5
Syracuse, NY 13210
Phone (315) 464-5726

Interoperability endpoints

  • Direct secure messaging: kle6605@direct.upstate.edu

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1187222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687478400000",
    "number": "1982896635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725 E. ADAMS STREET",
            "address_2": "5TH FL",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "13210",
            "telephone_number": "315-464-5726",
            "fax_number": "315-464-2500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 E. ADAMS STREET",
            "address_2": "5TH FL",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "13210",
            "telephone_number": "315-464-5726",
            "fax_number": "315-464-2500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LE",
        "first_name": "KHUYET",
        "middle_name": "T",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-16",
        "last_updated": "2023-06-23",
        "certification_date": "2023-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "011913",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03123508",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.