Provider Demographics
NPI:1285775510
Name:THONGKHAM, VILAY (DO)
Entity type:Individual
Prefix:
First Name:VILAY
Middle Name:
Last Name:THONGKHAM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7160 NEWCASTLE PL
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76182-5045
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7160 NEWCASTLE PL
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76182-5045
Practice Address - Country:US
Practice Address - Phone:682-203-9107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3766207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX190147202Medicaid
TX190147203Medicaid
TX190147204Medicaid
TXTXB100831Medicare PIN
TX190147203Medicaid
TX190147204Medicaid
TXTXB100834Medicare PIN