Provider Demographics
NPI:1174672927
Name:DO, KHANH GIA (MD)
Entity Type:Individual
Prefix:
First Name:KHANH
Middle Name:GIA
Last Name:DO
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 1:1439 SW MILITARY DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-1539
Mailing Address - Country:US
Mailing Address - Phone:210-924-6565
Mailing Address - Fax:210-924-4835
Practice Address - Street 1:1439 SW MILITARY DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78221-1539
Practice Address - Country:US
Practice Address - Phone:210-924-6565
Practice Address - Fax:210-924-4835
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6405207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110200645OtherMEDICARE RR
TX111807703OtherMEDICAID EPSDT
TX111807704Medicaid
TX8P1460OtherBCBS OF TEXAS
TX111807704Medicaid
TXG41126Medicare UPIN