Provider Demographics
NPI:1811905896
Name:KHAUV, KIM LANG (DDS)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:LANG
Last Name:KHAUV
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:LANG
Other - Last Name:KHAUV
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:750 N CAPITOL AVE
Mailing Address - Street 2:B5
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95133
Mailing Address - Country:US
Mailing Address - Phone:408-926-8446
Mailing Address - Fax:408-926-8001
Practice Address - Street 1:750 N CAPITOL AVE
Practice Address - Street 2:B5
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95133
Practice Address - Country:US
Practice Address - Phone:408-926-8446
Practice Address - Fax:408-926-8001
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA429251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB4292501OtherDENTICAL