Provider Demographics
NPI:1366514606
Name:KHOEUR, HONG VENG (PA-C)
Entity type:Individual
Prefix:MR
First Name:HONG
Middle Name:VENG
Last Name:KHOEUR
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4881 E BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-2324
Mailing Address - Country:US
Mailing Address - Phone:559-456-3955
Mailing Address - Fax:559-456-9931
Practice Address - Street 1:4881 E BELMONT AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-2324
Practice Address - Country:US
Practice Address - Phone:559-456-3955
Practice Address - Fax:559-456-9931
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16815363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant