Provider Demographics
NPI:1033673678
Name:TO, KEVIN MINHKHA (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:MINHKHA
Last Name:TO
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 HOMESTEAD RD APT F
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60526-1161
Mailing Address - Country:US
Mailing Address - Phone:323-245-7021
Mailing Address - Fax:
Practice Address - Street 1:190 S PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-3271
Practice Address - Country:US
Practice Address - Phone:630-617-3707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program