Provider Demographics
NPI:1093030462
Name:THIEU, KHANH PHAM (MD)
Entity Type:Individual
Prefix:DR
First Name:KHANH
Middle Name:PHAM
Last Name:THIEU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 N EAGLE RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-3400
Mailing Address - Country:US
Mailing Address - Phone:610-789-7546
Mailing Address - Fax:610-789-7547
Practice Address - Street 1:109 N EAGLE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-3400
Practice Address - Country:US
Practice Address - Phone:610-789-7546
Practice Address - Fax:610-789-7546
Is Sole Proprietor?:No
Enumeration Date:2010-03-29
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0012141207N00000X, 207ND0900X
PAMD454380207ND0900X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology