Provider Demographics
NPI:1487672432
Name:VO, KIM LOAN THI (MD)
Entity Type:Individual
Prefix:DR
First Name:KIM LOAN
Middle Name:THI
Last Name:VO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 FORDHAM RD
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-7326
Mailing Address - Country:US
Mailing Address - Phone:570-655-7186
Mailing Address - Fax:
Practice Address - Street 1:1111EAST END BLVD
Practice Address - Street 2:MEDICAL SERVICE
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:17711
Practice Address - Country:US
Practice Address - Phone:570-824-3521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA025999E207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAVAD000Medicare UPIN