Provider Demographics
NPI:1154942282
Name:DO, KHANH PHUONG (MD)
Entity type:Individual
Prefix:DR
First Name:KHANH
Middle Name:PHUONG
Last Name:DO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1110 N LEE AVE # 300
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-2612
Mailing Address - Country:US
Mailing Address - Phone:405-231-3000
Mailing Address - Fax:405-231-3073
Practice Address - Street 1:1110 N LEE AVE # 300
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-2612
Practice Address - Country:US
Practice Address - Phone:405-231-3000
Practice Address - Fax:405-231-3073
Is Sole Proprietor?:No
Enumeration Date:2020-04-29
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK41464207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine