Provider Demographics
NPI: | 1245404383 |
---|---|
Name: | HO, DONGHAI VIET (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | DONGHAI |
Middle Name: | VIET |
Last Name: | HO |
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: | 89 SYLVANIA DR |
Mailing Address - Street 2: | |
Mailing Address - City: | BEAVERCREEK |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 45440-3281 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 937-320-5125 |
Mailing Address - Fax: | 937-320-0504 |
Practice Address - Street 1: | 89 SYLVANIA DR |
Practice Address - Street 2: | |
Practice Address - City: | BEAVERCREEK |
Practice Address - State: | OH |
Practice Address - Zip Code: | 45440-3281 |
Practice Address - Country: | US |
Practice Address - Phone: | 937-320-5125 |
Practice Address - Fax: | 937-320-0504 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2008-04-18 |
Last Update Date: | 2013-02-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OH | 35098717 | 174400000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 174400000X | Other Service Providers | Specialist |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OH | 000000775565 | Other | ANTHEM |
OH | 000000775570 | Other | ANTHEM |
OH | 000000775567 | Other | ANTHEM |
OH | 0067533 | Medicaid | |
OH | 01657950 | Other | AMERIGROUP |
OH | 1245404383 | Other | NPI |
OH | H111681 | Medicare PIN | |
OH | 000000775570 | Other | ANTHEM |