Provider Demographics
NPI:1093818445
Name:KHO-DUFFIN, JENNIE S (MD)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:S
Last Name:KHO-DUFFIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9550 ZIONSVILLE RD
Mailing Address - Street 2:SUITE #200
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-1065
Mailing Address - Country:US
Mailing Address - Phone:317-872-0116
Mailing Address - Fax:317-874-1440
Practice Address - Street 1:10291 N MERIDIAN ST STE 100
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46290-1000
Practice Address - Country:US
Practice Address - Phone:317-874-1254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01046947A207ZC0500X, 207ZP0102X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN351609041OtherINDIANA COMPREHENSIVE
200193120OtherCARESOURCE RBMC
7118072OtherAETNA
IN112178OtherANTHEM BLUE SHIELD
IN200193120Medicaid
G83829OtherMERCY HEALTH PLAN
7118072OtherAETNA
IN200193120Medicaid
IN112178OtherANTHEM BLUE SHIELD
G83829OtherMERCY HEALTH PLAN