Provider Demographics
NPI:1225119571
Name:DINH, KHANH H (PA)
Entity Type:Individual
Prefix:
First Name:KHANH
Middle Name:H
Last Name:DINH
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5719 WIDEWATERS PKWY
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13214-1880
Mailing Address - Country:US
Mailing Address - Phone:315-251-3100
Mailing Address - Fax:315-449-9923
Practice Address - Street 1:5719 WIDEWATERS PKWY
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13214-1880
Practice Address - Country:US
Practice Address - Phone:315-251-3100
Practice Address - Fax:315-449-9923
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008759-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
970029764Medicare PIN
P76499Medicare UPIN
DD3882Medicare PIN