Provider Demographics
NPI:1245404383
Name:HO, DONGHAI VIET (MD)
Entity type:Individual
Prefix:
First Name:DONGHAI
Middle Name:VIET
Last Name:HO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 SYLVANIA DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45440-3281
Mailing Address - Country:US
Mailing Address - Phone:937-320-5125
Mailing Address - Fax:937-320-0504
Practice Address - Street 1:89 SYLVANIA DR
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45440-3281
Practice Address - Country:US
Practice Address - Phone:937-320-5125
Practice Address - Fax:937-320-0504
Is Sole Proprietor?:No
Enumeration Date:2008-04-18
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35098717174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000775565OtherANTHEM
OH000000775570OtherANTHEM
OH000000775567OtherANTHEM
OH0067533Medicaid
OH01657950OtherAMERIGROUP
OH1245404383OtherNPI
OHH111681Medicare PIN
OH000000775570OtherANTHEM