Provider Demographics
NPI:1730108473
Name:TA, ANDREW KHANH (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:KHANH
Last Name:TA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3101 ROYAL PALM AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-3937
Mailing Address - Country:US
Mailing Address - Phone:305-538-4191
Mailing Address - Fax:305-534-8026
Practice Address - Street 1:1611 NW 12TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1005
Practice Address - Country:US
Practice Address - Phone:305-585-6913
Practice Address - Fax:305-585-0000
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME72682207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services