Provider Demographics
NPI:1689757189
Name:KHO, NATHANIEL ACEBEDO (M D)
Entity Type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:ACEBEDO
Last Name:KHO
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 941408
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75094-1408
Mailing Address - Country:US
Mailing Address - Phone:972-247-5884
Mailing Address - Fax:972-247-5933
Practice Address - Street 1:9 MEDICAL PKWY STE 107
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7852
Practice Address - Country:US
Practice Address - Phone:972-247-5884
Practice Address - Fax:972-247-5933
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC1900X
TXK98232084N0402X, 2084N0600X, 2084P0800X, 2084S0012X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Single Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0007465251OtherAETNA PROVIDER NUMBER
TX4242217OtherBLUELINK ID
TX16MNOtherBCBS GROUP NUMBER
TX8298271OtherCIGNA PROVIDER NUMBER
TX8R9390OtherBCBS PROVIDER NUMBER
TX4242217OtherBLUELINK ID
TX8R9390OtherBCBS PROVIDER NUMBER