Provider Demographics
NPI:1770951550
Name:KHANG, VINCENT LEE (DDS)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:LEE
Last Name:KHANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 N WIGET LN
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2404
Mailing Address - Country:US
Mailing Address - Phone:925-946-1951
Mailing Address - Fax:925-946-1959
Practice Address - Street 1:218 N WIGET LN
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2404
Practice Address - Country:US
Practice Address - Phone:925-946-1951
Practice Address - Fax:925-946-1959
Is Sole Proprietor?:No
Enumeration Date:2015-09-10
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1024081223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics