Provider Demographics
NPI:1033274238
Name:KHOWONG, ANTOINETTE T (MEDICAL DOCTOR)
Entity Type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:T
Last Name:KHOWONG
Suffix:
Gender:F
Credentials:MEDICAL DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 MEDICAL PLAZA DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-2865
Mailing Address - Country:US
Mailing Address - Phone:916-782-2229
Mailing Address - Fax:916-797-9414
Practice Address - Street 1:5 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE 250
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2865
Practice Address - Country:US
Practice Address - Phone:916-782-2229
Practice Address - Fax:916-797-9414
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS6252207V00000X
CAA105245207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology