Provider Demographics
NPI:1326487380
Name:MORIN, VAN KHANH (DDS)
Entity Type:Individual
Prefix:DR
First Name:VAN
Middle Name:KHANH
Last Name:MORIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 PLAZA DR STE J
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-2940
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:530 PLAZA DR STE J
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-2940
Practice Address - Country:US
Practice Address - Phone:812-376-9335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-22
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INA120120001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice