Provider Demographics
NPI:1598139685
Name:VO, KHANH (RPH)
Entity Type:Individual
Prefix:
First Name:KHANH
Middle Name:
Last Name:VO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15951 MOUNT MITCHELL CIR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-1310
Mailing Address - Country:US
Mailing Address - Phone:858-336-3743
Mailing Address - Fax:
Practice Address - Street 1:120 S HARBOR BLVD STE B
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-1382
Practice Address - Country:US
Practice Address - Phone:714-760-4485
Practice Address - Fax:714-760-4449
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-30
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63636183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist