Provider Demographics
NPI:1679657357
Name:KHA, OANH NGUY (OD)
Entity Type:Individual
Prefix:DR
First Name:OANH
Middle Name:NGUY
Last Name:KHA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 WINDERMERE AVE
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-2313
Mailing Address - Country:US
Mailing Address - Phone:650-961-2020
Mailing Address - Fax:
Practice Address - Street 1:1350 GRANT RD STE 17
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-3248
Practice Address - Country:US
Practice Address - Phone:650-961-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 12627T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU592ZMedicare PIN
V08146Medicare UPIN