Basic Information
Provider Information | |||||||||
NPI: | 1720306442 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | DO | ||||||||
FirstName: | KHANH | ||||||||
MiddleName: | THIHONG | ||||||||
NamePrefix: | MISS | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | DO | ||||||||
OtherFirstName: | KATINA | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: | MISS | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D. | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 829641 | ||||||||
Address2: |   | ||||||||
City: | PHILADELPHIA | ||||||||
State: | PA | ||||||||
PostalCode: | 191825008 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2673705296 | ||||||||
FaxNumber: | 2152303725 | ||||||||
Practice Location | |||||||||
Address1: | 595 W STATE ST | ||||||||
Address2: |   | ||||||||
City: | DOYLESTOWN | ||||||||
State: | PA | ||||||||
PostalCode: | 189012554 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2153452885 | ||||||||
FaxNumber: | 2153452552 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/05/2010 | ||||||||
LastUpdateDate: | 09/30/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 09/30/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD458132 | PA | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
No ID Information.