Provider Demographics
NPI:1881681427
Name:DO, KHOA (MD)
Entity Type:Individual
Prefix:
First Name:KHOA
Middle Name:
Last Name:DO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:55 HIGHLAND AVE
Mailing Address - Street 2:STE. 304
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-2185
Mailing Address - Country:US
Mailing Address - Phone:978-741-4171
Mailing Address - Fax:978-741-4283
Practice Address - Street 1:55 HIGHLAND AVE
Practice Address - Street 2:STE 304
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2100
Practice Address - Country:US
Practice Address - Phone:978-741-4171
Practice Address - Fax:978-741-4283
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2009-05-08
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Provider Licenses
StateLicense IDTaxonomies
MA158958207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA011376Medicaid
MA011376Medicaid
H29186Medicare UPIN
MAA31886Medicare PIN