Provider Demographics
NPI:1710193479
Name:KHANG, FOUA CHOUA
Entity Type:Individual
Prefix:
First Name:FOUA
Middle Name:CHOUA
Last Name:KHANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 LAWSON AVE E
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-3917
Mailing Address - Country:US
Mailing Address - Phone:651-367-4337
Mailing Address - Fax:
Practice Address - Street 1:1983 SLOAN PL
Practice Address - Street 2:SUITE 1
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55117-2087
Practice Address - Country:US
Practice Address - Phone:651-326-5650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter