Provider Demographics
NPI:1255842753
Name:KHUU, WAIMIN
Entity Type:Individual
Prefix:
First Name:WAIMIN
Middle Name:
Last Name:KHUU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WENTWORTH PL
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-1828
Mailing Address - Country:US
Mailing Address - Phone:757-329-9208
Mailing Address - Fax:
Practice Address - Street 1:600 J CLYDE MORRIS BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-1820
Practice Address - Country:US
Practice Address - Phone:757-599-6264
Practice Address - Fax:757-599-6264
Is Sole Proprietor?:No
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202216123183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist