Provider Demographics
NPI:1063694875
Name:LE, LYNDA KIM (PA-C)
Entity type:Individual
Prefix:
First Name:LYNDA
Middle Name:KIM
Last Name:LE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12634 TRIANGLE REEF CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-6118
Mailing Address - Country:US
Mailing Address - Phone:215-805-0477
Mailing Address - Fax:
Practice Address - Street 1:3305 NASSAU ST
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4140
Practice Address - Country:US
Practice Address - Phone:206-895-1825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY23012294363A00000X
NVPA1228363A00000X
NVPA0219363A00000X
NVPA2360363A00000X
WAPA61139478363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
11973110OtherCAQH