Provider Demographics
NPI:1144253709
Name:HO, KHANH TUONG (MD)
Entity type:Individual
Prefix:DR
First Name:KHANH
Middle Name:TUONG
Last Name:HO
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 1:7777 HENNESSY BLVD
Mailing Address - Street 2:SUITE 501A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4300
Mailing Address - Country:US
Mailing Address - Phone:225-765-6505
Mailing Address - Fax:225-765-1223
Practice Address - Street 1:7777 HENNESSY BLVD
Practice Address - Street 2:SUITE 501A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4300
Practice Address - Country:US
Practice Address - Phone:225-765-6505
Practice Address - Fax:225-765-1223
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA024760207RR0500X
LA24760207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1575615Medicaid
4J109Medicare PIN
LA1575615Medicaid