Provider Demographics
NPI:1770510638
Name:DINH, KHUONG TUAN
Entity Type:Individual
Prefix:
First Name:KHUONG
Middle Name:TUAN
Last Name:DINH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4117 S STAPLES ST
Mailing Address - Street 2:SUITE 320
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-5505
Mailing Address - Country:US
Mailing Address - Phone:361-993-6117
Mailing Address - Fax:361-992-1375
Practice Address - Street 1:4117 S STAPLES ST
Practice Address - Street 2:SUITE 320
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-5505
Practice Address - Country:US
Practice Address - Phone:361-993-6117
Practice Address - Fax:361-992-1375
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6068TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX16193OtherSPECTERA
TX412069309OtherCHIP
TX451932OtherNVA
TX153761501Medicaid
TX38695OtherAVESIS
TX57092OtherSAFEGUARD
TX9917OtherDAVIS VISION
TX412069309OtherSUPERIOR VISION
TX919125OtherBLOCK VISION
TX9917OtherDAVIS VISION
TX16193OtherSPECTERA