Provider Demographics
NPI:1336327683
Name:HA, NGUYEN KHOI (MD)
Entity Type:Individual
Prefix:DR
First Name:NGUYEN
Middle Name:KHOI
Last Name:HA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 10069
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92423-0069
Mailing Address - Country:US
Mailing Address - Phone:909-335-4188
Mailing Address - Fax:909-478-3644
Practice Address - Street 1:1690 BARTON RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4229
Practice Address - Country:US
Practice Address - Phone:843-669-4156
Practice Address - Fax:843-664-2122
Is Sole Proprietor?:No
Enumeration Date:2008-02-07
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA130540207W00000X
SC35393207W00000X
MDD72579207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA130540OtherMEDICARE
SC353931Medicaid