Provider Demographics
NPI:1053751727
Name:LE, WENDY KIM (DPM, MPH)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:KIM
Last Name:LE
Suffix:
Gender:F
Credentials:DPM, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 S 13TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-5234
Mailing Address - Country:US
Mailing Address - Phone:267-253-5792
Mailing Address - Fax:
Practice Address - Street 1:170 N HENDERSON RD STE 310
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-2155
Practice Address - Country:US
Practice Address - Phone:610-672-8988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-26
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEE10000236213E00000X
PASC006510213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA496086D0KMedicare UPIN
DE522133ZH5DMedicare UPIN