Provider Demographics
NPI:1972652733
Name:KHANH GIA DO, MD PA
Entity Type:Organization
Organization Name:KHANH GIA DO, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KHANH
Authorized Official - Middle Name:GIA
Authorized Official - Last Name:DO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-924-6565
Mailing Address - Street 1:1439 SW MILITARY DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-1539
Mailing Address - Country:US
Mailing Address - Phone:210-924-6565
Mailing Address - Fax:210-924-4835
Practice Address - Street 1:1439 SW MILITARY DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78221-1539
Practice Address - Country:US
Practice Address - Phone:210-924-6565
Practice Address - Fax:210-924-4835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0036LTOtherBCBS OF TEXAS
TX171454501Medicaid
TX171454501Medicaid