Provider Demographics
NPI:1720599400
Name:VO, KHANG MINH (RPH)
Entity Type:Individual
Prefix:
First Name:KHANG
Middle Name:MINH
Last Name:VO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 RILEY ST
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3511
Mailing Address - Country:US
Mailing Address - Phone:916-983-5862
Mailing Address - Fax:
Practice Address - Street 1:475 STATE HIGHWAY 49
Practice Address - Street 2:
Practice Address - City:SUTTER CREEK
Practice Address - State:CA
Practice Address - Zip Code:95685-4195
Practice Address - Country:US
Practice Address - Phone:209-267-5128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-20
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73962183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist