Provider Demographics
NPI:1821806340
Name:THET, PANPAN KO
Entity type:Individual
Prefix:
First Name:PANPAN
Middle Name:KO
Last Name:THET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PANPAN
Other - Middle Name:
Other - Last Name:KOTHET
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1000 ANNAPOLIS WAY APT 638
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-1747
Mailing Address - Country:US
Mailing Address - Phone:808-319-7069
Mailing Address - Fax:
Practice Address - Street 1:9300 DEWITT LOOP
Practice Address - Street 2:
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060-5285
Practice Address - Country:US
Practice Address - Phone:800-698-2411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant