Provider Demographics
NPI:1568534535
Name:KHNG, PHILIP (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:
Last Name:KHNG
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 SOUTH MENA STREET
Mailing Address - Street 2:
Mailing Address - City:MENA
Mailing Address - State:AR
Mailing Address - Zip Code:71953-2745
Mailing Address - Country:US
Mailing Address - Phone:541-479-3454
Mailing Address - Fax:
Practice Address - Street 1:1201 SOUTH MENA STREET
Practice Address - Street 2:
Practice Address - City:MENA
Practice Address - State:AR
Practice Address - Zip Code:71953-2745
Practice Address - Country:US
Practice Address - Phone:541-479-3454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD70601223G0001X
AR36431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice