Provider Demographics
NPI:1427825843
Name:LE, CAO KHANH HA (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:CAO KHANH HA
Middle Name:
Last Name:LE
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7230 WURZBACH RD APT 304
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-3861
Mailing Address - Country:US
Mailing Address - Phone:210-865-0308
Mailing Address - Fax:
Practice Address - Street 1:1100 NW LOOP 410 STE 700
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-2258
Practice Address - Country:US
Practice Address - Phone:469-294-9075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT88344133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered