Provider Demographics
NPI:1336980747
Name:TA, KHANH GIA (DO)
Entity type:Individual
Prefix:DR
First Name:KHANH
Middle Name:GIA
Last Name:TA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:DANNIE
Other - Middle Name:GIA
Other - Last Name:TA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:355 BARD AVE DEPT OF MEDICINE VILLA BLDG 1ST FLOOR
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-1664
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:355 BARD AVE DEPT OF MEDICINE VILLA BLDG 1ST FLOOR
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310
Practice Address - Country:US
Practice Address - Phone:718-818-2419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program