Provider Demographics
NPI:1932365962
Name:VO, VINH NGOC KHANH (DO)
Entity Type:Individual
Prefix:
First Name:VINH
Middle Name:NGOC KHANH
Last Name:VO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3006 SAN GABRIEL BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-2536
Mailing Address - Country:US
Mailing Address - Phone:626-733-8900
Mailing Address - Fax:626-940-5225
Practice Address - Street 1:3006 SAN GABRIEL BLVD
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-2536
Practice Address - Country:US
Practice Address - Phone:626-733-8900
Practice Address - Fax:626-940-5225
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-29
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A11474207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC70477FMedicaid
CAED693XMedicare PIN
CACB251821Medicare PIN
CAFHC70477FMedicaid
CA051872Medicare Oscar/Certification
CAW1508GMedicare PIN
CAED693ZMedicare PIN
CAED693YMedicare PIN
CAW1508EMedicare PIN